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)

2002

What does the background hormone therapy (HT) and breast cancer include?

In Using HRT (Hormone Replacement Therapy): Hormone Replacement Therapy and Breast Cancer Risk last updated on 07 January 2024, the (United States) Breastcancer.org explain:

“Years ago, before the link between HRT use and breast cancer risk was known, many women took HRT for years to ease menopausal symptoms and prevent bone loss. After 2002, when research linked HRT and breast cancer risk, the number of women taking HRT dropped dramatically.

Newer research that has followed women for a longer amount of time suggests the link between HRT and breast cancer risk is more complex than first thought, and using HRT remains a controversial topic”.2

Contraindication or Not

Is breast cancer a contraindication to the use of HT?

In The 2023 Practitioner’s Toolkit for Managing Menopause: Management – Considerations for All Women At Menopause, published online 30 October 2023, the authors note:

  • “Breast cancer is a contraindication to the use of MHT”.3

Risk

What is currently known about breast cancer risk and HT?

In Using HRT (Hormone Replacement Therapy): What Are the Risks of HRT? Breastcancer.org explain:

“Breast cancer risk differs depending on the type of HRT and a woman’s personal history of breast cancer”.4

Breast Cancer Risk

What else is is known about breast cancer risk and HT?

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”.5

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”.6

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

“Cancer risk from HRT is small and depends on many different things. This includes the type of HRT used, how long someone takes it for, their age, and general health. The benefits of taking HRT will be different for each person too. Cancer risk is only part of the decision on whether to take HRT. Your doctor can help you make an informed choice on what is right for you”.7

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”.8

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”.9

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”.10

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:

“It’s especially important to attend all your breast screening (mammogram) appointments if you’re taking HRT”.11

Breast Cancer Patients

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

In Using HRT (Hormone Replacement Therapy): Hormone Replacement Therapy and Breast Cancer Risk last updated on 07 January 2024, the (United States) Breastcancer.org explain:

“HRT also can increase your risk of the cancer coming back (recurrence) if you’ve been diagnosed with breast cancer in the past. Because of this risk, doctors usually recommend that women with a history of breast cancer should not take types of HRT that affect the entire body (called systemic HRT)”.12

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”.13

Questions To Ask

What questions can you ask about HT and your breast cancer risk?

In Using HRT (Hormone Replacement Therapy): Steps You Can Take Breastcancer.org explain:

“Menopausal side effects can reduce quality of life for some women. You have to weigh the benefits of HRT against the risks.

If you’re having severe hot flashes or other menopausal side effects and are considering HRT, talk to your doctor about all of your options. Ask how you can relieve your symptoms while minimizing your breast cancer risk. Some questions you may want to ask:

  • What is my personal risk of breast, ovarian, endometrial, and other types of cancer? How will this risk be affected by HRT?
  • What is my personal risk of other conditions that HRT can affect, such as heart disease and stroke?
  • What other options are there — including non-hormonal medicines and complementary therapies — to treat menopausal symptoms and osteoporosis?
  • Would topical HRT be a good option for me?”14

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”.15

Health Topics A-Z

Where may I find Health Topics A-Z 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. 8 Myths and Truths About Menopausal Hot Flashes
  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. BMS TV: Bioidentical Hormones
  7. BMS TV: HRT and Bleeding
  8. BMS TV: HRT and Breast Cancer: Overall Risks and Benefits
  9. Bioidentical Hormones: Are They Safer?
  10. Breast Cancer
  11. Breast Cancer Risk Factors
  12. Breast Cancer: Risk Factors
  13. Breastcancer.org
  14. Breastcancernow.org
  15. Cancer Diagnosis: 11 Tips for Coping
  16. Cognitive Behaviour Therapy (CBT) for Menopausal Symptoms
  17. Compounded Bioidentical Hormone Therapy [Video]
  18. Deciding About Hormone Therapy
  19. Deciding About Hormone Therapy Use
  20. Dr Louise Newson: The Truth About the Menopause & HRT
  21. Emerging Research In the Management of Menopausal Symptoms
  22. Emotional Wellness In Menopause
  23. Endometrial Safety of Low-Dose Vaginal Estrogens
  24. Endometrial Safety of Low-Dose Vaginal Estrogens [Video]
  25. Estrogen Dependent Cancers
  26. Estrogen Therapy and Breast Cancer In Randomized Clinical Trials: A Narrative Review
  27. Find A Menopause Practitioner [United States and Other]
  28. Find An AMS Doctor [Australasian Menopause Society i.e. Australia and New Zealand]
  29. Find Your Nearest BMS Menopause Specialist [British Menopause Society]
  30. HRT & Menopause Extra [Video]
  31. HRT – Types, Doses and Regimens
  32. HRT: Benefits and Risks
  33. HRT: The History
  34. Hormone Replacement Therapy
  35. Hormone Replacement Therapy (HRT)
  36. Hormone Replacement Therapy (HRT) With Dr Nicky Peel & Prof. David Armstrong [Video]
  37. Hormone Replacement Therapy (HRT): Benefits and Risks of Hormone Replacement Therapy (HRT)
  38. Hormone Replacement Therapy (HRT): Types of Hormone Replacement Therapy (HRT)
  39. Hormone Therapy: Four Things A Mayo Clinic Women’s Health Specialist Wants You To Know
  40. Hormone Therapy: Is It Right for You?
  41. Hot Flashes
  42. Hot Flashes
  43. Hot Flashes: What Can I Do? [+ Video: What Are the Signs and Symptoms of Menopause?]
  44. How Mindfulness Meditation Improves Mental Health
  45. How To Find Relief for Hot Flashes At Night
  46. How To Prevent Cancer: 6 Ways To Lower Your Risk
  47. I Forgot To Ask the Doctor – E9: The Menopause: Can Every Woman That Wants It Have HRT?
  48. 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
  49. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Hormone Replacement Therapy (HRT) [+ Video: Is HRT Bad for You?] [Other Languages and Formats]
  50. Lubricant Alternatives: What To Use and What To Avoid
  51. Mayo Clinic Minute: Help With Hot Flashes Due To Menopause [+ Video Courtesy: Mayo Clinic News Network]
  52. Mayo Clinic Minute: How Lifestyle Changes May Help Manage Menopause Symptoms [+ Video]
  53. Menopausal Hormone Therapy and Breast Cancer Risk
  54. Menopausal Hormone Therapy and Breast Cancer Risk: Individualization Is the Key To Safety
  55. Menopausal Hormone Therapy: Why We Should No Longer Be Afraid of the Breast Cancer Risk [11 February 2022]
  56. Menopause
  57. Menopause Map: Downloadable Resources – My Personal Path Print Tools: Questions for Your Health Care Provider
    Hormone Therapy and Breast Cancer
  58. Menopause Mindfulness: Understanding the Many Paths To Menopause
  59. Menopause Patient Information [Videos] 2. Talking To Your GP About Menopause
  60. Menopause Patient Information [Videos] 3. The Risks & Benefits of HRT
  61. Menopause Preparedness Toolkit Video Series: Treating Vasomotor Symptoms of Menopause
  62. Menopause Preparedness Toolkit: A Woman’s Empowerment Guide
  63. Menopause Treatment Options After Cancer [Video]
  64. Menopause and Breast Cancer [Video]
  65. Menopause and HRT [Breast Cancer Risk]
  66. Menopause, Perimenopause, Hormone Therapy and Other Treatments With Madelyn Butler, MD [Podcast]
  67. Menopause: Diagnosis and Management – Information for the Public: Questions To Ask About Menopause [NICE Guideline]
  68. Menopause: Things You Can Do
  69. Mymenoplan.org [My Menoplan, United States]
  70. National Center for Complementary and Integrative Health: Cancer and Complementary Health Approaches: What You Need To Know
  71. Navigating Menopause: Expert Insights and Solutions | Dr Susan Davis | The Proof Podcast EP 245
  72. Randomized Trials of Estrogen-Alone and Breast Cancer Incidence: A Meta-Analysis
  73. Reassuring Data Regarding the Use of Hormone Therapy At Menopause and Risk of Breast Cancer [September 2022]
  74. Risks and Benefits of MHT
  75. The 2023 Practitioner’s Toolkit for Managing Menopause
  76. The Truth About Menopause Supplements | Dr Sarah Berry
  77. The Women’s Health Initiative Randomized Trials and Clinical Practice
  78. The Women’s Health Initiative Randomized Trials of Menopausal Hormone Therapy and Breast Cancer: Findings In Context
  79. Therapy for the Effects of Menopause
  80. Tips To Help Manage Menopause Symptoms
  81. ‘Tis But A Scratch: A Critical Review of the Women’s Health Initiative Evidence Associating Menopausal Hormone Therapy With the Risk of Breast Cancer
  82. Type of Menopausal Hormone Therapy May Influence Cancer Risk
  83. Types of Hormone Therapy
  84. Understanding Hormone Replacement Therapy
  85. Using HRT (Hormone Replacement Therapy)
  86. Using Natural Therapies In the Menopause Transition – Webinar
  87. Vaginal Dryness: What To Do About It
  88. Video Series-2022: Hormone Therapy: Understanding the Risks and Benefits
  89. Video Series-2023: Lifestyle Modification and Prevention of Breast Cancer
  90. Video Series-2023: NAMS 2023 Nonhormone Therapies Position Statement for Bothersome Menopause Symptoms
  91. Video Series-2023: New FDA-Approved Nonhormone Option for the Treatment of Hot Flashes
  92. Video Series-2024: Preparing for Your Menopause Health Care Visit
  93. Videos and Podcasts: Videos – Interviews: A Simple Approach To Menopause: The Menopause Quick Six (www.MQ6.ca)
  94. Videos and Podcasts: Videos – Interviews: The Women’s Health Initiative – What Can We Believe?
  95. Webinars: Previous – Non-Hormonal Pharmacological Interventions For VMS
  96. Webinars: Previous – Non-Pharmacological Interventions For VMS
  97. Webinars: Previous – Non-Pharmacological Interventions For VMS
  98. What if HRT isn’t right for me? And is cold-water swimming really the answer to everything? Your Menopause Questions Answered
  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: 31 March 2024
  2. Using HRT (Hormone Replacement Therapy): Hormone Replacement Therapy and Breast Cancer Risk. Last Updated: 07 January 2024. Breastcancer.org https://www.breastcancer.org/risk/risk-factors/using-hormone-replacement-therapy Accessed: Accessed: 31 March 2024
  3. Davis, S. R., Taylor, S., Hemachandra, C., Magraith, K., Ebeling, P. R., Jane, F., and Islam, R. M. The 2023 Practitioner’s Toolkit for Managing Menopause: Management – Considerations for All Women At Menopause: Menopausal Hormone Therapy. Published Online: 30 October 2023 https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783 Accessed: 31 March 2024
  4. Using HRT (Hormone Replacement Therapy): What Are the Risks of HRT? Last Updated: 07 January 2024. Breastcancer.org https://www.breastcancer.org/risk/risk-factors/using-hormone-replacement-therapy Accessed: Accessed: 31 March 2024
  5. 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: 31 March 2024
  6. 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: 31 March 2024
  7. Does Hormone Replacement Therapy Increase the Risk of Cancer? Should I Take HRT? Last Reviewed: 22 March 2023. Research UK https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/hormones-and-cancer/does-hormone-replacement-therapy-increase-cancer-risk#breast Accessed: 31 March 2024
  8. 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: 31 March 2024
  9. 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: 31 March 2024
  10. 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: 31 March 2024
  11. Hormone Replacement Therapy (HRT): Risks – Breast Cancer. Page Last Reviewed: 08 February 2023. NHS https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/risks/#breast-cancer Accessed: 31 March 2024
  12. Using HRT (Hormone Replacement Therapy): Hormone Replacement Therapy and Breast Cancer Risk. Last Updated: 07 January 2024. Breastcancer.org https://www.breastcancer.org/risk/risk-factors/using-hormone-replacement-therapy Accessed: Accessed: 31 March 2024
  13. 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: 31 March 2024
  14. Using HRT (Hormone Replacement Therapy): Steps You Can Take. Last Updated: 07 January 2024. Breastcancer.org https://www.breastcancer.org/risk/risk-factors/using-hormone-replacement-therapy Accessed: Accessed: 31 March 2024
  15. 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: 31 March 2024
Topic Last Updated: 11 June 2024 – Topic Last Reviewed: 31 March 2024

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