Hormone Therapy and Breast Cancer

“Current evidence suggests that oestrogen alone HRT
is associated with a lower risk of breast cancer
than combined HRT”.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 (HT) 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 elaborate on:

  • “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 is known about HT and breast cancer risk?

On page two and 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 online 10 June 2022, one of the recommendations is:

“Current evidence suggests that oestrogen alone HRT is associated with a lower risk of breast cancer than combined HRT. Breast cancer risk is duration dependent and may vary with the type of progestogen used. The risk of breast cancer should be considered in the context of the overall benefits and risks associated with HRT intake”.3

In Menopausal Hormone Therapy and Breast Cancer Risk: Summary of Findings, published 2022, the European Menopause and Andropause Society (EMAS) explain:

  • “Estrogen-alone systemic menopausal hormone therapy does not significantly increase and may even reduce breast cancer risk.
  • Low-dose topical estrogen does not increase breast cancer risk.
  • Combined menopausal hormone therapy confers a small increased risk but this decreases after treatment is stopped.
  • Risk differs according to the progestogen used, being higher with medroxyprogesterone acetate, levonorgestrel and norethisterone and lower with dydrogesterone and progesterone.
  • Breast cancer risk has to be put into clinical perspective, with account taken of other risk factors”.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, according to the North American Menopause Society (NAMS):

“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 Menopausal Hormone Therapy and Breast Cancer Risk: Summary of Findings the EMAS note:

  • “Regular alcohol consumption, obesity and physical inactivity increase the risk of breast cancer by 32–46%, 26–152%, and 7–33% respectively. This is much higher than the risk conferred by menopausal hormone therapy”.7

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

“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 note:

“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 last updated on 30 June 2022, the (United States) Breastcancer.org explain:

“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 last updated on 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 online 10 June 2022, one of the recommendations is:

“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 last updated on 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:

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

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:

Health Topics A-Z

Links

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Links

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New or Updated

  1. 20 Years of Data Lead To Changes In Perceptions, Usage of Menopausal HT
  2. 9 Myths and Misunderstandings About Menopausal Hormone Therapy (MHT)
  3. Askearlymenopause.org [Ask EM] [+ Video: What Is Early Menopause?]
  4. Association of Menopausal Hormone Therapy With Breast Cancer Incidence and Mortality During Long-Term Follow-Up of the Women’s Health Initiative Randomized Clinical Trials
  5. BMS & WHC’s 2020 Recommendations on Hormone Replacement Therapy In Menopausal Women
  6. Bioidentical Hormones Explained – A British Menopause Society Video
  7. Bioidentical Hormones: Are They Safer?
  8. Breast Cancer
  9. Breast Cancer Risk Associated With HRT Increases With Longer Use, Finds Study
  10. Breast Cancer: Risk Factors
  11. Breastcancer.org
  12. Breastcancernow.org
  13. Cognitive Behaviour Therapy (CBT) for Menopausal Symptoms
  14. Combined Menopausal Hormone Therapy (MHT)
  15. Complementary and Alternative Therapies Explained – A British Menopause Society Video
  16. Compounded Bioidentical Hormone Therapy [Video]
  17. Deciding About Hormone Therapy
  18. Deciding About Hormone Therapy Use
  19. Dr Gail Busby – I Forgot To Ask the Doctor – Episode 9 The Menopause
  20. Dr. Lisa Larkin – Breast Health Made Personal
  21. Estrogen Dependent Cancers
  22. Estrogen Therapy and Breast Cancer In Randomized Clinical Trials: A Narrative Review
  23. Find A Menopause Practitioner [United States and Other]
  24. Find An AMS Doctor [Australasian Menopause Society i.e. Australia and New Zealand]
  25. Find Your Nearest BMS Menopause Specialist [British Menopause Society]
  26. HRT & Menopause Extra
  27. HRT and Breast Cancer Statement In Response To EMA Pharmacovigilance Risk Assessment Committee Recommendations In May 2020
  28. HRT and Breast Cancer: Overall Risks and Benefits Explained – A British Menopause Society Video
  29. HRT and the Risk of Breast Cancer Explained – A British Menopause Society Video
  30. HRT – Types, Doses and Regimens
  31. HRT: Benefits and Risks
  32. HRT: The History
  33. Hormone Replacement Therapy
  34. Hormone Replacement Therapy (HRT)
  35. Hormone Replacement Therapy (HRT) Explained – A British Menopause Society Video
  36. Hormone Replacement Therapy (HRT) With Dr Nicky Peel & Prof. David Armstrong
  37. Hormone Replacement Therapy (HRT): Benefits and Risks
  38. Hormone Replacement Therapy (HRT): Types
  39. Hormone Therapy: Is It Right for You?
  40. Hot Flashes
  41. Hot Flashes
  42. Hot Flashes: What Can I Do? [+ Video: What Are the Signs and Symptoms of Menopause?]
  43. How To Find Relief for Hot Flashes At Night
  44. Jean Hailes MHT Position Statement
  45. 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
  46. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Hormone Replacement Therapy (HRT) [+ Video: Is HRT Bad for You?]
  47. MHT Still Maligned & Misunderstood: Expert
  48. MHT and Breast Cancer Risk
  49. MHT and Breast Cancer – Risk Even Lower, Study Reports
  50. Making Decisions About Hormone Replacement Therapy
  51. Making Sense of Menopausal Hormone Therapy Means Understanding the Benefits As Well As the Risks
  52. Mayo Clinic Minute: Help With Hot Flashes Due To Menopause [+ Video Courtesy: Mayo Clinic News Network]
  53. Mayo Clinic Minute: How Lifestyle Changes May Help Manage Menopause Symptoms [+ Video]
  54. Menopausal Hormone Therapy (MHT) for the Management of Menopausal Symptoms: Position Statement
  55. Menopausal Hormone Therapy Regimens Have Opposite Lasting Effects on Breast Cancer Incidence
  56. Menopausal Hormone Therapy and Breast Cancer Risk
  57. Menopausal Hormone Therapy and Breast Cancer Risk: Individualization Is the Key To Safety
  58. Menopausal Hormone Therapy and Cancer
  59. Menopausal Hormone Therapy and Long-Term Breast Cancer Risk: Further Data From the Women’s Health Initiative Trials
  60. Menopausal Hormone Therapy: Why We Should No Longer Be Afraid of the Breast Cancer Risk
  61. Menopause
  62. Menopause
  63. Menopause Experts Dismiss Some Breast Cancer Claims In New Report
  64. Menopause Management Options: Menopausal Hormone Therapy (MHT)
  65. Menopause Map: Downloadable Resources – My Personal Path Print Tools: Questions for Your Health Care Provider
    XHormone Therapy and Breast Cancer
  66. Menopause Patient Information [Videos] 2. Talking To Your GP About Menopause
  67. Menopause Patient Information [Videos] 3. The Risks & Benefits of HRT
  68. Menopause Patient Information [Videos] 4. The Different Types of HRT
  69. Menopause Preparedness Toolkit Video Series: Treating Vasomotor Symptoms of Menopause
  70. Menopause Symptoms: Mayo Clinic Expert Outlines Hormone and Nonhormonal Therapies
  71. Menopause Treatments: What Works, What Doesn’t
  72. Menopause: Diagnosis & Treatment
  73. Menopause: Diagnosis and Management – Information for the Public: Questions To Ask About Menopause [NICE Guideline]
  74. National Center for Complementary and Integrative Health: Cancer In-Depth
  75. National Center for Complementary and Integrative Health: Menopausal Symptoms: In Depth
  76. Navigating Menopause: Expert Insights and Solutions | Dr Susan Davis | The Proof Podcast EP 245
  77. Oestrogen Only Menopausal Hormone Therapy
  78. Optimising the Menopause Transition: 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
  79. Risks and Benefits of MHT
  80. Systemic or Vaginal Hormone Therapy After Early Breast Cancer: A Danish Observational Cohort Study
  81. The IMS Has Released A Statement: Use of Hormone Replacement Therapy (HRT) and Risk of Breast Cancer
  82. 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”
  83. The North American Menopause Society Releases Its 2022 Hormone Therapy Position Statement
  84. The Women’s Health Initiative Randomized Trials of Menopausal Hormone Therapy and Breast Cancer: Findings In Context
  85. Tips To Help Manage Menopause Symptoms
  86. Types of Hormone Therapy
  87. Understanding Breast Cancer Risk
  88. Understanding Hormone Replacement Therapy
  89. Using HRT (Hormone Replacement Therapy)
  90. Using Natural Therapies In the Menopause Transition – Webinar
  91. Video Series-2022: Hormone Therapy: Understanding the Risks and Benefits
  92. Video Series-2022: Understanding Screening Guidelines for Breast Cancer and the Importance of Identifying Risk Factors
  93. Video Series-2023: Lifestyle Modification and Prevention of Breast Cancer
  94. Videos and Podcasts: Videos – Interviews: Scientific Advances In Early Cancer Detection. What the Future Holds
  95. Videos and Podcasts: Videos – Interviews: The Women’s Health Initiative – What Can We Believe?
  96. Webinars: Previous – Breast Cancer
  97. Webinars: Previous – The Early Menopausal Patient
  98. What Are the Benefits and Risks of HRT?
  99. Why Didn’t Anyone Tell Me This? Episode 3: Dr Annice Mukherjee: Your Essential Menopause Toolkit
  100. Why We Don’t Have Good Evidence To Show That HRT Is Safe After Breast Cancer [Video]

Sources

Where may I find the Sources quoted?

You may find the Sources quoted at:

Sources

  1. Hamoda, H., Mukherjee, A., Morris, E., Baldeweg, S. E., Jayasena, C. N., Briggs, P., Moger, S. 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 Online 10 June 2022:2-3. https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 22 March 2023
  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: 22 March 2023
  3. Hamoda, H., Mukherjee, A., Morris, E., Baldeweg, S. E., Jayasena, C. N., Briggs, P., Moger, S. 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 Online 10 June 2022:2-3. https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 22 March 2023
  4. Menopausal Hormone Therapy and Breast Cancer Risk: Summary of Findings. 2022 European Menopause and Andropause Society https://emas-online.org/wp-content/uploads/2022/05/Menopausal-hormone-therapy-and-breast-cancer-risk.pdf Accessed: 22 March 2023
  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: 22 March 2023
  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: 22 March 2023
  7. Menopausal Hormone Therapy and Breast Cancer Risk: Summary of Findings. 2022 European Menopause and Andropause Society https://emas-online.org/wp-content/uploads/2022/05/Menopausal-hormone-therapy-and-breast-cancer-risk.pdf Accessed: 22 March 2023
  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: 22 March 2023
  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: 22 March 2023
  10. Making Decisions About Hormone Replacement Therapy. Last Updated on: 30 June 2022. Breastcancer.org https://www.breastcancer.org/tips/menopausal/hrt/decisions Accessed: 22 March 2023
  11. Making Decisions About Hormone Replacement Therapy. Last Updated on: 30 June 2022. Breastcancer.org https://www.breastcancer.org/tips/menopausal/hrt/decisions Accessed: 22 March 2023
  12. Hamoda, H., Mukherjee, A., Morris, E., Baldeweg, S. E., Jayasena, C. N., Briggs, P., Moger, S. 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 Online 10 June 2022:3-4. https://journals.sagepub.com/doi/full/10.1177/20533691221104879 Accessed: 22 March 2023
  13. Making Decisions About Hormone Replacement Therapy. Last Updated on: 30 June 2022. Breastcancer.org https://www.breastcancer.org/tips/menopausal/hrt/decisions Accessed: 22 March 2023
  14. Hormone Therapy: Is It Right for You? Who Can Benefit From Hormone Therapy? If You Take Hormone Therapy, How Can You Reduce Risk? 06 December 2022. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-therapy/art-20046372 Accessed: 22 March 2023
Topic Last Updated: 22 March 2023 – Topic Last Reviewed: 22 March 2023

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