HRT may quadruple your risk of deadly cancer

As I wrote a few weeks ago, hormone replacement therapy (HRT) has long been a controversial decision for women after menopause. In that first e-Alert, I added another check in HRT’s “Con” column; a new study suggested that these supplemental hormones may increase a woman’s risk of developing insulin resistance and Type II diabetes.

Now, there’s another new study in the anti-HRT camp. This one strongly supports the long-held belief that HRT may increase a woman’s risk of breast cancer – in fact, it shows that long-term HRT use may boost your odds of one of the most dangerous types of breast cancer by as much as 85 PERCENT.
Estrogen alone or with progestin – either way, the risk is very real

In this study at the University of Washington in Seattle, researchers selected 705 post-menopausal women between the ages of 50 and 74 who were newly diagnosed with invasive breast cancer between July 1990 and December 1995. (Invasive breast cancer has spread to surrounding tissues, while non-invasive is contained to the original site. Therefore, invasive breast cancer is considered more serious.) They also chose 692 healthy women of the same age as controls. All of the women were enrolled at the Group Health Cooperative of Puget Sound (GHC), which provided medical care and prescription services. By searching the GHC records, the researchers could determine each woman’s health history and her HRT status.

The researchers tracked whether the women had ever taken hormone replacement therapy, and if so, whether they took estrogen alone or a combination of estrogen and progestin. (This study did not track the affects of HRT patches, injections, or progestin cream.) They established a reference date for each woman: for cases, the reference date was one year before breast cancer diagnosis; for controls, a comparable reference date was selected. Then they analyzed each woman’s HRT use for the five consecutive years prior to the reference date.
HRT quadrupled risk for most dangerous form of breast cancer

This study also broke down the results between two different types of invasive breast cancer: non-lobular and lobular. Non-lobular invasive cancers (also called ductal) are the most common type of invasive breast cancer, accounting for about 75 percent of all cases. Invasive lobular cancer is much rarer, making up only 5 to 10 percent of all breast cancer cases. It’s also much more dangerous and aggressive, and difficult to detect by mammogram or physical exam, because it is located in the lobes, in the deepest part of the breast.

In general, the study revealed the risk of either form of breast cancer was 60 to 85 percent higher for women who used any form of HRT for four and a half years or more, the researchers’ definition of “long-term use.” But when they broke the results down between lobular and non-lobular cancers, the results were even more frightening. Long-term users of oral estrogen had nearly THREE TIMES the risk of developing lobular breast cancer, and long-term users of combination therapy had nearly FOUR TIMES the risk of the most dangerous form of the disease.

There’s been plenty of research in the past to suggest that there was a significant association between HRT and breast cancer. But this study spells out the risk in such stark terms – and it establishes a connection with this rarer, more deadly form of cancer.

If you’re still weighing the HRT issue, this study provides important new information that could influence your decision. And if you already take oral HRT, talk to your doctor about these risks. Better yet, ask your doctor to read this study; it was published in the February 13, 2002 issue of the Journal of the American Medical Association. (For the full citation, see the Source information below.)

Remember, post-menopausal women have many alternatives to synthetic HRT. Many women have used herbal remedies, like dong quai, black cohosh, licorice, and chasteberry, to effectively manage the side-effects of menopause. Nutritional approaches like supplemental vitamin A, C, and B vitamins, plus minerals like boron have also been shown to be effective.
Ultimately, it’s each woman’s decision. But that decision should be made with all the relevant facts on the table. We’ll keep bringing you everything we find on HRT – both the “pros” and the “cons,” so you can make the decision that’s best for you.

Source: Journal of the American Medical Association 2002;287:734-741