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)

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”.2

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”.3

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”.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

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”.8

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”.9

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”.10

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”.11

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”.12

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”.13

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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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 Statement on Testosterone
  7. BMS TV: Bioidentical Hormones
  8. BMS TV: HRT and Bleeding
  9. BMS TV: HRT and Breast Cancer: Overall Risks and Benefits
  10. BMS TV: Menopause Explained
  11. BMS TV: Menopause – Weight Gain, Nutrition and Lifestyle
  12. Bioidentical Hormones: Are They Safer?
  13. Breast Cancer
  14. Breast Cancer Risk Factors
  15. Breast Cancer: Risk Factors
  16. Breastcancer.org
  17. Breastcancernow.org
  18. Cancer Diagnosis: 11 Tips for Coping
  19. Cognitive Behaviour Therapy (CBT) for Menopausal Symptoms
  20. Compounded Bioidentical Hormone Therapy [Video]
  21. Deciding About Hormone Therapy
  22. Deciding About Hormone Therapy Use
  23. Dr Louise Newson: The Truth About the Menopause & HRT
  24. Emerging Research In the Management of Menopausal Symptoms
  25. Emotional Wellness In Menopause
  26. Endometrial Safety of Low-Dose Vaginal Estrogens
  27. Endometrial Safety of Low-Dose Vaginal Estrogens [Video]
  28. Estrogen Dependent Cancers
  29. Estrogen Therapy and Breast Cancer In Randomized Clinical Trials: A Narrative Review
  30. Find A Menopause Practitioner [United States and Other]
  31. Find An AMS Doctor [Australasian Menopause Society i.e. Australia and New Zealand]
  32. Find Your Nearest BMS Menopause Specialist [British Menopause Society]
  33. HRT & Menopause Extra
  34. HRT – Types, Doses and Regimens
  35. HRT: Benefits and Risks
  36. HRT: The History
  37. Hormone Replacement Therapy
  38. Hormone Replacement Therapy (HRT)
  39. Hormone Replacement Therapy (HRT) With Dr Nicky Peel & Prof. David Armstrong
  40. Hormone Replacement Therapy (HRT): Benefits and Risks of Hormone Replacement Therapy (HRT)
  41. Hormone Replacement Therapy (HRT): Types of Hormone Replacement Therapy (HRT)
  42. Hormone Therapy: Is It Right for You?
  43. Hot Flashes
  44. Hot Flashes
  45. Hot Flashes: What Can I Do? [+ Video: What Are the Signs and Symptoms of Menopause?]
  46. How Mindfulness Meditation Improves Mental Health
  47. How To Find Relief for Hot Flashes At Night
  48. How To Prevent Cancer: 6 Ways To Lower Your Risk
  49. I Forgot To Ask the Doctor – E9: The Menopause: Can Every Woman That Wants It Have HRT?
  50. 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
  51. Later Years (Around 50 Years and Over): Menopause and Post Menopause Health – Hormone Replacement Therapy (HRT) [+ Video: Is HRT Bad for You?]
  52. Lubricant Alternatives: What To Use and What To Avoid
  53. Making Decisions About Hormone Replacement Therapy
  54. Mayo Clinic Minute: Help With Hot Flashes Due To Menopause [+ Video Courtesy: Mayo Clinic News Network]
  55. Mayo Clinic Minute: How Lifestyle Changes May Help Manage Menopause Symptoms [+ Video]
  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: Why We Should No Longer Be Afraid of the Breast Cancer Risk
  59. Menopause
  60. Menopause Map: Downloadable Resources – My Personal Path Print Tools: Questions for Your Health Care Provider
    Hormone Therapy and Breast Cancer
  61. Menopause Mindfulness: Understanding the Many Paths To Menopause
  62. Menopause Patient Information [Videos] 2. Talking To Your GP About Menopause
  63. Menopause Patient Information [Videos] 3. The Risks & Benefits of HRT
  64. Menopause Patient Information [Videos] 4. The Different Types of HRT
  65. Menopause Preparedness Toolkit Video Series: Treating Vasomotor Symptoms of Menopause
  66. Menopause Preparedness Toolkit: A Woman’s Empowerment Guide
  67. Menopause Symptoms: Mayo Clinic Expert Outlines Hormone and Nonhormonal Therapies
  68. Menopause Treatments: What Works, What Doesn’t
  69. Menopause and HRT [Breast Cancer Risk]
  70. Menopause, Perimenopause, Hormone Therapy and Other Treatments With Madelyn Butler, MD [Podcast]
  71. Menopause: Diagnosis and Management – Information for the Public: Questions To Ask About Menopause [NICE Guideline]
  72. Menopause: Things You Can Do
  73. Mymenoplan.org [My Menoplan, United States]
  74. National Center for Complementary and Integrative Health: Cancer and Complementary Health Approaches: What You Need To Know
  75. Navigating Menopause: Expert Insights and Solutions | Dr Susan Davis | The Proof Podcast EP 245
  76. Nonhormone Treatments for Hot Flashes and Night Sweats
  77. Prosayla Supported by ISSWSH [International Society for the Study of Women’s Sexual Health]
  78. Risks and Benefits of MHT
  79. Systemic or Vaginal Hormone Therapy After Early Breast Cancer: A Danish Observational Cohort Study
  80. The Truth About Menopause Supplements | Dr Sarah Berry
  81. The Women’s Health Initiative Randomized Trials of Menopausal Hormone Therapy and Breast Cancer: Findings In Context
  82. Therapy for the Effects of Menopause
  83. Tips To Help Manage Menopause Symptoms
  84. ‘Tis But A Scratch: A Critical Review of the Women’s Health Initiative Evidence Associating Menopausal Hormone Therapy With the Risk of Breast Cancer
  85. Types of Hormone Therapy
  86. Understanding Hormone Replacement Therapy
  87. Using HRT (Hormone Replacement Therapy)
  88. Using Natural Therapies In the Menopause Transition – Webinar
  89. Vaginal Dryness: What To Do About It
  90. Video Series-2022: Hormone Therapy: Understanding the Risks and Benefits
  91. Video Series-2022: Understanding Screening Guidelines for Breast Cancer and the Importance of Identifying Risk Factors
  92. Video Series-2023: Lifestyle Modification and Prevention of Breast Cancer
  93. Video Series-2023: Racial and Ethnic Differences in the Menopause Experience
  94. Video Series-2023: NAMS 2023 Nonhormone Therapies Position Statement for Bothersome Menopause Symptoms
  95. Video Series-2023: New FDA-Approved Nonhormone Option for the Treatment of Hot Flashes
  96. Videos and Podcasts: Videos – Interviews: A Simple Approach To Menopause: The Menopause Quick Six (www.MQ6.ca)
  97. Videos and Podcasts: Videos – Interviews: The Women’s Health Initiative – What Can We Believe?
  98. Webinars: Previous – Breast Cancer
  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 August 2023
  2. 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 August 2023
  3. 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 August 2023
  4. 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: 22 August 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 August 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 August 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 August 2023
  8. Hormone Replacement Therapy (HRT): Risks – Breast Cancer. Page Last Reviewed: 09 February 2023. NHS https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/risks/#breast-cancer Accessed: 22 August 2023
  9. Making Decisions About Hormone Replacement Therapy. Last Updated on: 30 June 2022. Breastcancer.org https://www.breastcancer.org/tips/menopausal/hrt/decisions Accessed: 22 August 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 August 2023
  11. 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 August 2023
  12. Making Decisions About Hormone Replacement Therapy. Last Updated on: 30 June 2022. Breastcancer.org https://www.breastcancer.org/tips/menopausal/hrt/decisions Accessed: 22 August 2023
  13. 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 August 2023
Topic Last Updated: 20 October 2023 – Topic Last Reviewed: 22 August 2023

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