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HRT Raises Risk of Breast Cancer Death

Combined Hormone Replacement Therapy May Be more Deadly for Some

Sorting Out the Risks and Benefits of HRT continued...

A. First, we identify the reasons she is considering treatment with HRT, such as the severity of her symptoms, bone density, risk of breast cancer, cholesterol levels, and personal ideas about hormones.

Then, we go through our current understanding of the risk and benefits of hormone replacement therapy, largely based on the results of the WHI study but also other data. For example, we discuss:

  • The increase in heart events, breast cancer, and gallstones
  • The decreases in hip factures and colon cancers found with HRT
  • The study that found that women who were 65 and older when they started hormones had an increase in dementia
  • The fact that HRT tends to make the breast denser and harder to spot breast cancers through mammograms, which increases the likelihood that a woman on HRT might have an abnormal mammogram. This could lead to unnecessary testing, such as a breast biopsy.

Q. How do you explain the increase in breast cancer risk associated with HRT use shown by the WHI study?

A. The number I use with my patients is that an extra eight out of 10,000 women using estrogen-plus-progestin HRT developed breast cancer per year -- that translates to 0.08 per 100. Then, we actually calculate their individual statistical risk and show them that the risk of breast cancer is actually higher from their own statistical chance and that the increase from hormones for most women is a small increase.

My advice is to look at the absolute increased risk seen with HRT and to interpret it in terms of the particular woman and her own risks and benefits. Eight additional cases per 10,000 women is a very small number, but it's very significant to those eight women. It's also very important for women who are at risk for breast cancer to know that they are increasing their chance of breast cancer with long-term use of HRT.

Q. How has your discussion about the risks and benefits of HRT for women entering menopause changed?

A. The biggest difference is that before the WHI study, we felt hormones would treat the symptoms, decrease their chances of heart disease and hip fracture without increasing the risk for breast cancer, and potentially decrease the chance of Alzheimer's disease.

Now, when women come in we're primarily focusing on relief of menopausal symptoms and educating them that we don't think that we're preventing heart disease or Alzheimer's and that we are slightly increasing their chance of breast cancer.

Q. What about older women who are already on HRT? What are their concerns?

A. For women in the 55- to 60-year age group, they are most concerned about their risk for breast cancer. We identify their statistical chance of having breast cancer and then talk about the potential added risk from long-term use of HRT, look at their bone density, and for most women who have been on HRT for more than five years, we either lower the dose or taper them off.

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