A new study on breast cancer and HRT

Jean Hailes endocrinologist, Dr Sonia Davison says that the decision to use HRT (also known as MHT, menopausal hormone therapy) is never an easy one. One of the main concerns for women is the link between HRT and breast cancer. The recently reported study further examined the link between HRT and breast cancer in a large group of UK-based women.

The 'best' type of studies, in scientific terms, are called 'randomised controlled trials' and compare a treatment with a dummy treatment or 'placebo' in a large number of people, says Dr Davison. Guidelines for doctors choosing treatments for patients are usually based on the results of randomised controlled trials, or the pooled results of many randomised controlled studies.

We know from previous studies of this type that there is a link between combined HRT and breast cancer but that this link depends on the duration that HRT is used, the type of HRT used and in particular the type of progestogen the HRT contained.

This latest study is not a randomised controlled trial and doesn't tell us anything new, says Dr Davison.

The key things for women to know about the link between combined HRT and breast cancer are:

• The risk of breast cancer increases slightly following four to five years of combined HRT use
• The risk of breast cancer further increases with a long duration of HRT (up to or more than 15 years)
• The increased risk is only for HRT that contains the combination of oestrogen and progestogen, but not every progestogen has the same effects; some progestogens have a much stronger link with breast cancer
• There is no increased risk of breast cancer with oestrogen-only use (only recommended for those who have had a hysterectomy)

Around menopause, women can have bothersome symptoms due to low oestrogen, including hot flushes, night sweats, sleep disturbance, mood disturbance and other symptoms. These symptoms can be severe in 20% of women and can cause a significant reduction in quality of life and ability to function. Many women will benefit from HRT use around their menopause for symptom relief and some may need longer term therapy.

The consensus from menopause experts currently is that the benefits of HRT far outweigh the risks in healthy women who are within 10 years of menopause. These benefits not only include symptom relief but also protection from the development of osteoporosis and cardiovascular disease.

Regarding the decision to use HRT, the following are general recommendations for women:

• Be guided by a health professional who has expertise in this area so you can be fully informed as to the benefits and risks of HRT
• Use the lowest dose that controls symptoms for the shortest duration of time necessary
• Have a regular review with your doctor and undergo regular screening tests including a two yearly mammogram.

Read more information on the risks and benefits of HRT.