“The level of increased breast cancer risk
with MHT use varies,
according to which data is analysed”.1

Umbrella
What may the Hormone Therapy and Breast Cancer Umbrella include?

Depending on the Source (DotS) this Umbrella may include:

  • Breast Cancer
  • Cancer of the Breast
  • Hormone Replacement Therapy (HRT)
  • Hormone Therapy (HT)
  • Menopausal Hormone Therapy (MHT)

Different Differences

What is it important to understand about hormone therapy and breast cancer risk?

On page three Menopausal Hormone Therapy (MHT) for the Management of Menopausal Symptoms: Position Statement – The Jean Hailes Position: JH Notes the Following Evidence – 6b) Breast Cancer dated 07 April 2020, the (Australian) Jean Hailes for Women’s Health (JH) explain:

  • “The level of increased breast cancer risk with MHT use varies, according to which data is analysed. It is not possible to estimate an overall absolute risk of breast cancer by combining and examining all the available MHT research. Research studies may look at different types of MHT, different doses, different ages of women, different age of treatment initiation, different duration of use of MHT. All these factors may influence risk”.2

Breast Cancer Risk

What else is known about HT and breast cancer risk?

In Menopause Management: Menopausal Hormone Therapy (MHT) – Breast Cancer & MHT the JH elaborate on:

“For otherwise healthy women, taking MHT for 2-5 years to relieve menopausal symptoms causes little if any increase in breast cancer risk”.3

In Does Hormone Replacement Therapy Increase Cancer Risk? Does HRT Increase the Risk of Breast Cancer the (United Kingdom) Cancer Research UK elaborate on:

“Taking HRT for 1 year or less only slightly increases breast cancer risk. However, the longer you take HRT the greater the risks are, and the longer they last.

The risk of breast cancer due to HRT can also vary from person to person. Things such as what age you are when you first start taking HRT, other medicines you may be taking, and your general health can impact the risk.

People who begin HRT before or soon after the menopause may have a bigger risk than those who start HRT later”.4

Uterus

Hormone Therapy and Breast CancerIf a woman has a uterus and chooses to use estrogen plus progestogen therapy, what is her breast cancer risk?

On page one in Deciding About Hormone Therapy Use: Potential Risks published June 2022, the North American Menopause Society (NAMS) explain:

“Hormone therapy (combined estrogen and progestogen) might slightly increase your risk of breast cancer if used for more than 4 to 5 years”.5

No Uterus

Hormone Therapy and Breast CancerIf a woman does not have a uterus and chooses to use estrogen therapy, what is her breast cancer risk?

On page one in Deciding About Hormone Therapy Use: Potential Risks published June 2022, the NAMS explain:

“Using estrogen alone (for women without a uterus) does not increase breast cancer risk at 7 years but may increase risk if used for a longer time”.6

Risk Comparison

What puts a woman at a higher risk of developing breast cancer than taking HRT?

In Menopause Management: Menopausal Hormone Therapy (MHT) – Breast Cancer & MHT: Chance of Developing Breast Cancer In A Given Year the JH elaborate on:

“The following factors put you at a higher risk of developing breast cancer than taking MHT:

  • Having more than two standard alcoholic drinks per day
  • Being overweight or obese
  • Having your first child over the age of 35
  • Having your menopause in your late 50s

This risk should also be seen within the context of the benefits of MHT; taking MHT can significantly improve a woman’s quality of life and reduce the risk of developing osteoporosis, diabetes, colon cancer and possibly heart disease”.

In Does Hormone Replacement Therapy Increase Cancer Risk? Should I Take HRT? Cancer Research UK note:

“It’s also important to remember that there are other things that affect cancer risk more than HRT. For example, you can reduce your cancer risk by stopping smoking, keeping a healthy weight, and drinking less alcohol”.8

Breast Cancer Screening

If a woman chooses to use HT, what is important about breast cancer screening?

In Hormone Replacement Therapy (HRT): Risks – Breast Cancer the (United Kingdom) NHS explain:

“Because of the risk of breast cancer, it’s especially important to attend all your breast cancer screening appointments if you’re taking HRT”.9

At High Risk of Breast Cancer

Is HT recommended for those at high risk of breast cancer?

In Making Decisions About Hormone Replacement Therapy dated 30 June 2022, the (United States) Breastcancer.org note:

“There isn’t enough data to know if it is safe in women at high risk of breast cancer, but it’s probably not a good idea”.10

Breast Cancer Patients

Is HT recommended for women who have been diagnosed with breast cancer?

In Making Decisions About Hormone Replacement Therapy dated 30 June 2022, Breastcancer.org elaborate on:

“Research on menopausal hormone therapy will continue, as will the ongoing debate about benefits versus risks. At this point, HRT — whether in the form of combination HRT or estrogen-only HRT — is not recommended for women who have been diagnosed with breast cancer”.11

On page three in the Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause, first published 10 June 2022, Hamoda et al. include:

“A history of breast cancer should be considered a contraindication to systemic HRT. The risk of breast cancer recurrence with HRT is higher in women with oestrogen receptor positive cancer, but women with oestrogen receptor negative breast cancer are also considered to have an increased risk of recurrence with HRT. HRT may, in exceptional cases, be offered to women with breast cancer with severe menopausal symptoms if lifestyle modifications and non-hormonal treatment options are not effective. This should be done after discussion with the woman, her menopause specialist and her breast/oncology team”.12

Hormone Receptor-Negative Breast Cancer Patients

Can hormone receptor-negative (HR-) breast cancer patients take HT?

In Making Decisions About Hormone Replacement Therapy dated 30 June 2022, Breastcancer.org explain:

“Women who are diagnosed with hormone receptor-negative (HR-) breast cancer sometimes wonder whether HRT could be okay for them, since the cancer cells don’t appear to have receptors for the growth signals coming from hormones. In reality, though, even HR- cancers can contain some hormone receptor-positive cells (HR+) — and vice versa. And hormone receptor status actually can change over time. So you can’t use your hormone receptor status as an indicator of whether or not HRT is safe for you. Many studies of HRT and breast cancer risk didn’t differentiate between HR+ and HR- cancers, and that may explain some of the variations in results”.13

Health Care Provider

If I choose to use HT how can I follow up?

The (United States) Mayo Clinic note:

  • “See your doctor regularly to ensure that the benefits of hormone therapy continue to outweigh the risks, and for cancer screenings such as mammograms and pelvic exams”.14

The JH also note:

“Research and best-practice guidelines suggest that menopausal women review their reasons to continue MHT (or not) with their doctor once per year, or more regularly if they have any concerns”.15

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Sources

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Sources

  1. Menopausal Hormone Therapy (MHT) for the Management of Menopausal Symptoms: Position Statement – The Jean Hailes Position: JH Notes the Following Evidence – 6b) Breast Cancer. 07 April 2020:3. Jean Hailes for Women’s Health. https://assets.jeanhailes.org.au/JH_position-statement_MHT.pdf Accessed: 19 July 2022
  2. Menopausal Hormone Therapy (MHT) for the Management of Menopausal Symptoms: Position Statement – The Jean Hailes Position: JH Notes the Following Evidence – 6b) Breast Cancer. 07 April 2020:3. Jean Hailes for Women’s Health. https://assets.jeanhailes.org.au/JH_position-statement_MHT.pdf Accessed: 19 July 2022
  3. Menopause Management: Menopausal Hormone Therapy (MHT) – Breast Cancer & MHT. Last Updated: 13 July 2021 | Last Reviewed: 17 December 2017. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management Accessed: 19 July 2022
  4. Does Hormone Replacement Therapy Increase Cancer Risk? Does HRT Increase the Risk of Breast Cancer? Last Reviewed: 09 March 2021. Cancer Research UK https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/hormones-and-cancer/does-hormone-replacement-therapy-increase-cancer-risk#breast Accessed: 19 July 2022
  5. Deciding About Hormone Therapy Use: Potential Risks. 2022:1. North American Menopause Society https://www.menopause.org/docs/default-source/professional/menonote-deciding-about-ht-2022.pdf Accessed: 19 July 2022
  6. Deciding About Hormone Therapy Use: Potential Risks. 2022:1. North American Menopause Society https://www.menopause.org/docs/default-source/professional/menonote-deciding-about-ht-2022.pdf Accessed: 19 July 2022
  7. Menopause Management: Menopausal Hormone Therapy (MHT) – Breast Cancer & MHT: Chance of Developing Breast Cancer In A Given Year. Last Updated: 13 July 2021 | Last Reviewed: 17 December 2017. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management Accessed: 19 July 2022
  8. Does Hormone Replacement Therapy Increase Cancer Risk? Should I Take HRT? Last Reviewed: 09 March 2021. Research UK https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/hormones-and-cancer/does-hormone-replacement-therapy-increase-cancer-risk#breast Accessed: 19 July 2022
  9. Hormone Replacement Therapy (HRT): Risks – Breast Cancer. Page Last Reviewed: 09 September 2019. NHS https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/risks/#breast-cancer Accessed: 19 July 2022
  10. Making Decisions About Hormone Replacement Therapy. Last Updated: 30 June 2022. Breastcancer.org https://www.breastcancer.org/tips/menopausal/hrt/decisions Accessed: 19 July 2022
  11. Making Decisions About Hormone Replacement Therapy. Last Updated: 30 June 2022. Breastcancer.org https://www.breastcancer.org/tips/menopausal/hrt/decisions Accessed: 19 July 2022
  12. Hamoda et al. Joint Position Statement By the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on Best Practice Recommendations for the Care of Women Experiencing the Menopause. Fist published 10 June 2022:3-4. https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 19 July 2022
  13. Making Decisions About Hormone Replacement Therapy. Last Updated: 30 June 2022. Breastcancer.org https://www.breastcancer.org/tips/menopausal/hrt/decisions Accessed: 19 July 2022
  14. Menopause Hormone Therapy and Your Heart: How To Limit the Risks. 20 May 2021. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-replacement-therapy/art-20047550 Accessed: 19 July 2022
  15. Menopause Management: Menopausal Hormone Therapy (MHT) – Breast Cancer & MHT. Last Updated: 13 July 2021 | Last Reviewed: 17 December 2017. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management Accessed: 19 July 2022
Topic Last Updated: 23 August 2022 – Topic Last Reviewed: 19 July 2022

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