Correlation between hormone replacement therapy and the risk of breast cancer

For example, you can reduce your cancer risk by stopping smoking , keeping a healthy weight , and drinking less alcohol. Does HRT increase the risk of breast cancer? Most types of HRT increase the risk of breast cancer. But the risk is higher for those using combined HRT, which uses both oestrogen and progestogen.

Vaginal oestrogens are not linked to an increased risk of breast cancer, whereas tibolone is. Taking HRT for 1 year or less only slightly increases breast cancer risk. However, the longer you take HRT the greater the risks are, and the longer they last. The risk of breast cancer due to HRT can also vary from person to person. Things such as what age you are when you first start taking HRT, other medicines you may be taking, and your general health can impact the risk.

Does HRT increase the risk of ovarian cancer? Yes, both oestrogen-only and combined HRT slightly increase the risk of ovarian cancer. Does HRT increase the risk of womb endometrial cancer? The risk of womb cancer depends on the type of HRT. Oestrogen-only HRT increases the risk of womb cancer. The longer this type of HRT is used, the bigger the risk.

Combined HRT can reduce womb cancer risk. But combined treatment causes the biggest increase in breast cancer risk. Similar to oestrogen-only HRT, tibolone also increases the risk of womb cancer. Key references Beral, V. Breast cancer and hormone-replacement therapy in the Million Women Study. Although this is not the same as menopause, it can lead to many of the same symptoms. Most of the symptoms of menopause are linked to lower estrogen levels. Some symptoms — hot flashes and night sweats, for instance — tend to fade away at some point, whether or not they are treated.

Other problems that start after menopause, like dryness and thinning of vaginal tissues and bone thinning, tend to get worse over time. Because many of the symptoms and problems of menopause are linked to low levels of estrogen, this hormone has often been used in the past to treat menopause. What hormones are used to treat the symptoms of menopause? The hormones most commonly used to treat symptoms of menopause are estrogen and progesterone.

Progesterone and drugs that act like it are called progestins. Often, these 2 hormones are used together, but some women are given estrogen alone. Some preparations contain both an estrogen and a progestin. Androgens male hormones like testosterone are also sometimes used to treat menopausal symptoms.

Tibolone is a synthetic hormone drug that can act like estrogen, progesterone, and testosterone in different tissues of the body. Taking estrogen with a progestin vs. Although estrogen alone improves the symptoms of menopause, it increases the risk of cancer of the uterus endometrial cancer. Adding a progestin to the estrogen lowers the risk of endometrial cancer back to normal.

Because of this, EPT is given to women who still have a uterus those who have not had a hysterectomy. Women often prefer continuous EPT because it rarely leads to menstrual-like bleeding. Sequential cyclical EPT means different amounts of each hormone are taken on specific days. There are different ways to do this. For example, estrogen can be taken by itself for 14 days, then estrogen plus progestin for 11 days, then neither hormone for 3 to 5 days.

Other schedules involve taking progestin only every few months. This lowers the amount of progestin that you are exposed to. Monthly regimens are also thought to result in hormone levels that are more like the natural menstrual cycle. Cyclical EPT can produce bleeding like a menstrual period, but it can occur less often than monthly.

Sometimes, how much of the hormones the woman takes are adjusted based on blood tests of hormone levels. But so far, there are no long-term studies of bio-identical hormones, and no studies have found that women taking bio-identical hormones have less serious side effects than women taking other forms of these hormones. For this reason, bio-identical hormones should be assumed to have the same health risks as any other type of hormone therapy.

Some herbal remedies and supplements are also described as natural ways to treat the symptoms of menopause. ET improves the symptoms of menopause, but it increases the risk of cancer of the uterus endometrial cancer.

How are estrogen and progestin given to treat the symptoms of menopause? Systemic hormones Hormones can be given so that they enter the bloodstream and circulate to reach all parts of the body. A vaginal ring that delivers a large dose of estrogen to the whole body Vaginal rings more often deliver low doses and are considered topical therapy. See below. Systemic hormones can help with certain symptoms of menopause, such as hot flashes and night sweats, as well as problems linked to thinning of the lining of the vagina such as dryness that can make sex painful.

They can also help prevent and treat osteoporosis severe bone thinning. Topical hormones Hormones, most often estrogen, can also be placed in or near the place that needs treatment. This is called topical hormone therapy. If small doses are used, little of the hormone is absorbed into the bloodstream, so it has little if any effect on the rest of the body.

For women in menopause, very small doses of estrogen can be placed inside the vagina as topical therapy to help treat dry or thinned vaginal tissues. This type of estrogen comes in the form of vaginal creams, rings, and tablets. Even though tiny amounts of hormone may enter the blood, most of it stays in the vaginal tissues. Generally, topical estrogen is not needed in women taking systemic hormones. Types of studies of hormone therapy and cancer risk Different types of studies can be used to look at cancer risk from menopausal hormone therapy MHT.

Randomized controlled trials: In this kind of study, a group of patients get the drug being studied like MHT , and another control group gets a placebo like a sugar pill. Results from this kind of study are powerful because which group a patient is in is based on chance. This is the best way to see the effects of a drug. These types of studies can also be double-blinded, which means neither the people in the study nor their doctors know which group they are in.

This lowers the chance that thoughts or opinions about treatment could affect the study results. Unfortunately, these kinds of studies are costly, which limits the number of people in the study, how long the study can continue, and the number of studies done. In observational studies of MHT, the women and their doctors decide what hormone drugs, if any, the women take and for how long.

These kinds of studies can also gather information about other factors that can influence cancer risk. Some observational studies gather data about what happened over previous years. Others follow observe people for years to look at how different factors like MHT affect cancer risk. This makes it less clear that the differences seen are only due to the drug being studied like MHT and not other factors.

When observational studies and randomized controlled trials have different results, most experts give more weight to the results of the randomized controlled trial. Womens Health Initiative studies of hormone therapy and cancer risk Several large studies have looked at possible links between systemic hormone therapy in menopausal women and different types of cancer. Over 5, women in the ET group took a daily dose of estrogen in the form of conjugated equine estrogen CEE for an average of about 6 years.

The researchers then continued to follow them for several years to look for any further effects of the hormone. The women were compared to more than 5, in the placebo group. The other study looked at estrogen-progestin therapy EPT in post-menopausal women who still had their uterus. Over 8, women in the EPT group took a daily dose of CEE plus a progestin called medroxyprogesterone acetate for an average of about 5 years.

This group was compared to a group of more than 8, women in the placebo group. The WHI also conducted some observational studies. Many observational studies have looked at MHT and cancer risk. One example is the Million Women Study.

It enrolled over a million women aged 50 to 64 in the UK, collected information about hormone use and other health and personal details, and followed the women for many years. Some of the women on ET still had their uterus. Estrogen-progestin therapy EPT and cancer risk Endometrial cancer Studies show that EPT does not increase the risk of endometrial cancer cancer in the lining of the uterus.

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There is no evidence of an increased risk of breast cancer after ever use of exogenous estrogens. However, when long term use i. No consistent evidence exists on differing risks of breast cancer with different types of estrogens, and no clear dose-relationship has been found. Risk estimates for combined estrogen-progestogen regimens have been of the same magnitude as for estrogens alone; thus, no clear evidence of a protective effect of the addition of a progestogen has been found.

Investigations into a possible interaction between estrogen supplementation and other known risk factors for breast cancer have not yielded any consistent results. Cancers that develop during estrogen therapy have been found to be associated with a favourable prognosis. For combined progestogens, the increased risk was highest for norethisterone 1.

The risk associated with past long term oestrogen-progestogen use, however, remained increased 1. In recent oestrogen only users, between three in younger women and eight in older women extra cases per 10 women years would be expected, and in oestrogen-progestogen users between nine and 36 extra cases per 10 women years.

For past oestrogen-progestogen users, the results would suggest between two and eight extra cases per 10 women years. Conclusion: This study has produced new generalisable estimates of the increased risks of breast cancer associated with use of different hormone replacement preparations in the UK.

The levels of risks varied between types of HRT, with higher risks for combined treatments and for longer duration of use. Re-use permitted under CC BY. No commercial re-use.