HRT Raises Risk of Breast Cancer Death
Combined Hormone Replacement Therapy May Be more Deadly for Some
Aug. 7, 2003 -- Combined hormone replacement therapy (HRT)
using estrogen plus progestin may not only increase a woman's risk of breast
cancer, but it may also make her more likely to die from the disease.
A British study shows for the first time that HRT users are
more likely to die of breast cancer than women who have never used HRT, and the
breast cancer risks associated with combined estrogen-progestin hormone therapy
are up to four times greater than those associated with estrogen-only HRT.
The study, published in the Aug. 9 edition of The
Lancet, involved about 1 million women between the ages of 50 and 64 and
also confirms previous studies that found HRT slightly raises the risk of
breast cancer in postmenopausal women.
Half of the women were HRT users. A total of 9,364 breast
cancers were reported after an average of 2.6 years, and 637 deaths were
reported after an average of 4.1 years.
Researchers found the risk of breast cancer increased the
longer a woman used HRT, but this effect wore off within a few years after
stopping HRT. Women who had used HRT at the start of the study had an almost
70% higher risk of developing breast cancer and a 22% higher risk of dying from
it than women who never used HRT. Past users of HRT did not have an increased
risk of the disease or death from it.
The study showed that current use of combination HRT was
associated with a higher risk of breast cancer than estrogen-only HRT. The
longer HRT was used, the greater the risk. Also, the increased risk varied on
the type of estrogen and progestin as well as whether the women took the
hormones continuously or periodically.
Researchers estimate that for every 1,000 postmenopausal women
who take HRT for 10 years, use of estrogen-only HRT will cause an extra five
breast cancer cases and combined HRT will cause an extra 19 cases.
"Combined estrogen-progesterone HRT is usually prescribed
for women who still have a uterus, to avoid the increased risk of cancer of the
uterus caused by estrogen-only therapy," says researcher Valerie Beral,
professor at Cancer Research UK, in a news release.
"Since our results show a substantially greater increase in
breast cancer with combined HRT, women need to weigh the increased risk of
breast cancer caused by the addition of progestin against the lowered risk of
uterine cancer," says Beral. "Comparing the risks is by no means
simple, and women may well want to discuss options with their doctor."
In an editorial the accompanies the study, Chris van Wheel and
colleagues from the University of Nijmegen, Netherlands, say these findings are
in line with two recent studies published in The Journal of the American
Medical Association that found a higher risk of advanced or invasive breast
cancers in combination HRT users.
"The problem is in those women who are already, often for a
long time, taking HRT -- estimated at between 20% and 50% of all women 45-70
years of age in the western population," they write. "This group should
discontinue HRT use as soon as possible.
"Discontinuing HRT should be suggested in as supportive a
way as possible, because no one will benefit from panic or over-reaction:
general practitioners need to use the opportunities arising from their regular
contacts with patients taking HRT to discuss treatment-related risks, to give
advice about stopping, and to offer alternative support."