“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

Type and Timing of Menopausal Hormone Therapy and… Meta-Analysis

Hormone Therapy and Breast CancerHormone Therapy and Breast CancerWhat has feedback about Type and Timing of Menopausal Hormone Therapy and Breast Cancer Risk: Individual Participant Meta-Analysis of the Worldwide Epidemiological Evidence, published in the Lancet on 29 August 2019, included?

On page one in The International Menopause Society Comment on: “Type and Timing of Menopausal Hormone Therapy and Breast Cancer Risk: Individual Participant Meta-Analysis of the Worldwide Epidemiological Experience” the International Menopause Society (IMS) elaborate on:

“Is there new information that menopausal hormone therapy (MHT) substantially increases breast cancer risk as suggested by a paper published in the Lancet this month and should women be worried?

  • Much of the information regarding breast cancer risk and MHT reported in this paper is not new…
  • It is important to note that, because of when the data included in this report was collected, most of the MHT regimes were different from those used today
  • This paper provides an important public health message about obesity and breast cancer risk…”.3

What do the IMS recommend?

On page two in The International Menopause Society Comment on: “Type and Timing of Menopausal Hormone Therapy and Breast Cancer Risk: Individual Participant Meta-Analysis of the Worldwide Epidemiological Experience” the IMS explain:

“Recommendations From the IMS

Women enter menopause across a range of ages, with diverse symptoms and health risk profiles. The International Menopause Society advocates the comprehensive assessment of women, including attention to modifying risk factors for chronic disease such as being overweight or obese, the importance of which have been highlighted in this Lancet paper. The benefits and risks of MHT differ according to the timing of menopause such that individualisation of therapy is essential. As prescribing practices have changed significantly over the last decade, further research is needed to determine the impact of currently recommended regimens”.4

In Menopause Experts Dismiss Some Breast Cancer Claims In New Report the JH elaborate on:

“Australian menopause experts are urging women to talk to their doctor about their use of menopausal hormone therapy (MHT) if they have concerns following today’s publication of a large study linking MHT to an increased risk of breast cancer”.5

Where may I find Links related to Type and Timing of Menopausal Hormone Therapy and Breast Cancer Risk: Individual Participant Meta Analysis of the Worldwide Epidemiological Evidence, published in the Lancet on 29 August 2019?

Your Country may have Links similar to:

Revised Global Consensus Statement

What are some points of consensus about menopausal hormone therapy (MHT) and breast cancer risk?

Some points of consensus in the Revised Global Consensus Statement on Menopausal Hormone Therapy: Section A: Benefit/Risk Profile of MHT – endorsed by seven menopause-related organizations – published online 20 June 2016, are:

  • “The risk of breast cancer in women over 50 years of age associated with MHT is a complex issue with decreased risk reported from RCTs for estrogen alone (CE in the Women’s Health Initiative (WHI)) in women with hysterectomy and a possible increased risk when combined with a progestin (medroxyprogesterone acetate in the WHI) in women without hysterectomy. The increased risk of breast cancer thus seems to be primarily, but not exclusively, associated with the use of a progestin with estrogen therapy in women without hysterectomy and may be related to the duration of use
  • The risk of breast cancer attributable to MHT is rare. It equates to an incidence of <1.0 per 1000 women per year of use. This is similar or lower than the increased risk associated with common factors such as sedentary lifestyle, obesity and alcohol consumption. The risk may decrease after treatment is stopped, but data are inconsistent”.6

What is RCTs?

RCTs can be an abbreviation for Randomized Controlled Trials.

NICE Guideline

What do the (British) National Institute for Health and Care Excellence (NICE) guidelines note about HRT and breast cancer risk?

In Menopause: Diagnosis and Management – Information for the Public: Benefits and Risks of HRT last updated 15 December 2019, the NICE note:

“Studies show that for women around menopausal age:

  • Oestrogen only HRT causes little or no change in the risk of breast cancer
  • HRT that contains oestrogen and progestogen may increase breast cancer risk. This risk may be higher if you take HRT for longer but falls again when you stop taking HRT”.7

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”.8

In Does Hormone Replacement Therapy Increase Cancer Risk? Does HRT Increase the Risk of Breast Cancer, last reviewed 27 February 2019, Cancer Research UK (United Kingdom) elaborate on:

“The risk of breast cancer increases for postmenopausal women using any type of HRT. But it is biggest for those using combined HRT, which has the hormones oestrogen and progestogen. Risk is also higher in those who used HRT for more than 5 years”.9

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 in June 2017, 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”.10

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 in June 2017, the NAMS note:

“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”.11

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”.12 

Stop, Then What

Once a woman stops using HRT, what happens to her risk of breast cancer?

In Does Hormone Replacement Therapy Increase Cancer Risk? Does HRT Increase the Risk of Breast Cancer? Cancer Research UK note:

“But when HRT is stopped, risk of breast cancer will start to drop back down. It takes about 4 years for the risk to go down to the same level as those who have not used HRT”.13

Breast Cancer Screening

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

In Hormone Replacement Therapy (HRT): Risks – Breast Cancer the (United Kingdom) NHS (National Health Service) 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”.14

Breast Cancer Survivors

Can breast cancer survivors use HT?

One of the points of consensus in the Revised Global Consensus Statement on Menopausal Hormone Therapy: Section B: General Principles Governing the Use of MHT is:

  • “Current safety data do not support the use of systemic MHT in breast cancer survivors, although discussions, in selected women and in conjunction with each woman’s oncologist, may occur for compelling reasons after nonhormonal or complementary options have been unsuccessful”.15

In Making Decisions About Hormone Replacement Therapy, last modified on 02 November 2017, 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. 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”.16

Health Care Provider

If I choose to use HT what is my breast cancer risk?

Different women who choose to use HT can have different breast cancer risk. It may therefore be in your best interest to also choose to talk to your health care provider about this.

One of the points of consensus in the Revised Global Consensus Statement on Menopausal Hormone Therapy: Section B: General Principles Governing the Use of MHT is:

  • “The option of MHT is an individual decision in terms of quality of life and health priorities as well as personal risk factors such as age, time since menopause and the risk of VTE, stroke, ischemic heart disease and breast cancer. MHT should not be recommended without a clear indication for its use”.17

The (United States) Mayo Clinic also note:

  • “Seek regular follow-up care. See your health care provider regularly to ensure that the benefits of hormone therapy continue to outweigh the risks, and for cancer screenings such as mammograms and pelvic exams”.18

The JH 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”.19

Health Topics A-Z

Where may I find Health Topics related to Hormone Therapy and Breast Cancer?

In Health Topics A-Z you may find:

Links

Where may I find Links related to Hormone Therapy and Breast Cancer?

Your Country may have Links similar to:

Sources

Where may I find the Sources quoted?

You may find the Sources quoted at:

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: 20 July 2020
  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: 20 July 2020
  3. The International Menopause Society Comment on: “Type and Timing of Menopausal Hormone Therapy and Breast Cancer Risk: Individual Participant Meta-Analysis of the Worldwide Epidemiological Experience”. 29 August 2019:1. International Menopause Society https://www.imsociety.org/manage/images/pdf/2b650ccd4a2e0c63806d82ed2984ed69.pdf Accessed: 20 July 2020
  4. The International Menopause Society Comment on: “Type and Timing of Menopausal Hormone Therapy and Breast Cancer Risk: Individual Participant Meta-Analysis of the Worldwide Epidemiological Experience”. 29 August 2019:2. International Menopause Society https://www.imsociety.org/manage/images/pdf/2b650ccd4a2e0c63806d82ed2984ed69.pdf Accessed: 20 July 2020
  5. Menopause Experts Dismiss Some Breast Cancer Claims In New Report. 30 August 2019. Jean Hailes for Women’s Health https://jeanhailes.org.au/news/menopause-experts-dismiss-breast-cancer-claims-of-new-report Accessed: 20 July 2020
  6. De Villiers, T. J., Hall, J. E., Pinkerton, J. V., Pérez, S. C., Rees, M., Yang, C. and Pierroz, D. D. Revised Global Consensus Statement on Menopausal Hormone Therapy: Section A: Benefit/Risk Profile of MHT. Climacteric, 2016;19:4:314 https://www.imsociety.org/manage/images/pdf/ba6379e868044bec13015ac2b84f2753.pdf Accessed: 20 July 2020
  7. Menopause Diagnosis and Management: Information for the Public – Benefits and Risks of HRT: Breast Cancer. Published Date: 12 November 2015. Last Updated: 05 December 2019. National Institute for Health and Care Excellence https://www.nice.org.uk/guidance/ng23/ifp/chapter/Benefits-and-risks-of-HRT Accessed: 20 July 2020
  8. Menopause Management: Menopausal Hormone Therapy (MHT) – Breast Cancer & MHT. Last Updated: 07 April 2020 | Last Reviewed: 17 December 2017. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management Accessed: 20 July 2020
  9. Does Hormone Replacement Therapy Increase Cancer Risk? Does HRT Increase the Risk of Breast Cancer? Last Reviewed: 27 February 2019. Cancer Research UK https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/hormones-and-cancer/does-hormone-replacement-therapy-increase-cancer-risk#breast Accessed: 20 July 2020
  10. Deciding About Hormone Therapy Use: Potential Risks. 2017:1. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/menonote-deciding-about-ht-2017.pdf Accessed: 20 July 2020
  11. Deciding About Hormone Therapy Use: Potential Risks. 2017:1. North American Menopause Society https://www.menopause.org/docs/default-source/for-women/menonote-deciding-about-ht-2017.pdf Accessed: 20 July 2020
  12. Menopause Management: Menopausal Hormone Therapy (MHT) – Breast Cancer & MHT: Chance of Developing Breast Cancer In A Given Year. Last Updated: 07 April 2020 | Last Reviewed: 17 December 2017. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management Accessed: 20 July 2020
  13. Does Hormone Replacement Therapy Increase Cancer Risk? Does HRT Increase the Risk of Breast Cancer? Last Reviewed: 27 February 2019. Research UK https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/hormones-and-cancer/does-hormone-replacement-therapy-increase-cancer-risk#breast Accessed: 20 July 2020
  14. Hormone Replacement Therapy (HRT): Risks – Breast Cancer. Page Last Reviewed: 09 September 2019. NHS (National Health Service) https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/risks/#breast-cancer Accessed: 20 July 2020
  15. De Villiers, T. J., Hall, J. E., Pinkerton, J. V., Pérez, S. C., Rees, M., Yang, C. and Pierroz, D. D. Revised Global Consensus Statement on Menopausal Hormone Therapy: Section B: General Principles Governing the Use of MHT. Climacteric, 2016;19:4:314 https://www.imsociety.org/manage/images/pdf/ba6379e868044bec13015ac2b84f2753.pdf Accessed: 20 July 2020
  16. Making Decisions About Hormone Replacement Therapy. Last Modified on: 02 November 2017. Breastcancer.org https://www.breastcancer.org/tips/menopausal/hrt/decisions Accessed: 20 July 2020
  17. De Villiers, T. J., Hall, J. E., Pinkerton, J. V., Pérez, S. C., Rees, M., Yang, C. and Pierroz, D. D. Revised Global Consensus Statement on Menopausal Hormone Therapy: Section B: General Principles Governing the Use of MHT. Climacteric, 2016;19:4:314 https://www.imsociety.org/manage/images/pdf/ba6379e868044bec13015ac2b84f2753.pdf Accessed: 20 July 2020
  18. Menopause Hormone Therapy and Your Heart: How To Limit the Risks. 01 August 2018. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-replacement-therapy/art-20047550 Accessed: 20 July 2020
  19. Menopause Management: Menopausal Hormone Therapy (MHT) – Breast Cancer & MHT. Last Updated: 07 April 2020 | Last Reviewed: 17 December 2017. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-management Accessed: 20 July 2020

Topic Last Updated: 16 September 2020 – Topic Last Reviewed: 20 July 2020
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