“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

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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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