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
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