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A A new in-depth analysis adds to the evidence that many women who undergo hormone therapy during menopause are more likely to develop breast cancer – and have a higher risk of cancer for more than ten years after they stop taking these medications.
The study, published Thursday in the Lancet, examined data from dozens of studies, including long-term data on more than 100,000 women who developed breast cancer after menopause. Half of these women had used what is called a menopausal hormone treatment, or THM. The more women took the medicine, the more likely they were to develop breast cancer. Experts say the findings could influence how women and their health care providers decide how to manage the symptoms of menopause.
"It's a consensus of many researchers and many studies from around the world. These are important new findings, "said Valerie Beral, a cancer epidemiologist at Oxford University and one of the lead authors of the new study.
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Women have long been prescribed synthetic versions to replace hormones that decrease during menopause. Medications – usually given as a tablet, but sometimes as a patch, gel or injection – provide women with either estrogen or a combination of estrogen and progesterone. For many women, they help alleviate the symptoms of menopause, including osteoporosis.
For years, research has suggested a potential link between HRT and an increased risk of breast cancer. In 2002 and 2004, the Women's Health Initiative published reports that women who used combined HRT were more likely to develop breast cancer. The use of ESM decreased after widespread coverage of reports. This was followed by a decline in breast cancer rates.
But there was not much information about the persistence of this risk, nor about the difference in risk depending on the type of EMS taken by a woman. An international group of researchers has therefore collected data from dozens of studies – published and unpublished – to examine the issue more closely. They took the woman's age when first using the TMS, how long she used the medicine, and how long she had been using it. The average age of women starting menopause was 50, which also corresponds to the average age at which women began using ESM.
The researchers found that, compared to women who had never used THM, the risk of developing invasive breast cancer was significantly higher among women. They estimated that 6.3% of women who had never used THM had developed breast cancer, compared to 8.3% of women who had used the combination drug continuously for five years. This is roughly an additional diagnosis of cancer for 50 users.
The longer women had been using THM, the higher their risk of breast cancer. Women who no longer used MHT had a lower relative risk than women who were currently using it – but they were at high risk for more than a decade after stopping this medication. The level of risk depended on how long a woman was taking a TSM. The study also found that women who took the combination drug were more likely to develop cancer than women who took the drug containing only estrogen.
"The results are significant," said Joanne Kotsopoulos, a researcher on breast cancer at Toronto's Women's College Research Institute. "The longer you use it, the higher the risk," added Kotsopoulos, who did not participate in the research, but wrote a commentary on the study, also published in the Lancet .
The new analysis does not show that HTH directly causes breast cancer. But researchers suspect that this association has to do with the hormonal changes of menopause. The level of hormones produced by the ovaries decreases considerably during menopause. Early menopause is thought to reduce the risk of breast cancer. However, the use of IMS could keep women in a state similar to that of pre-menopause, preventing them from getting the protective benefits of menopause on the risk of cancer.
"Estrogen stimulates activity in the breast and increases the risk of breast cancer. [MHT] is just putting back that stimulus that had reigned after menopause, "said Beral.
The caveat: The results, in general, apply to middle-weight women in developed countries. The researchers found that THM did not have a significant adverse effect on obese women, although obesity is also a risk factor for breast cancer after menopause.
For now, experts believe that patients and providers should carefully consider the potential benefits of using HAS against risk. Alternatives to MHT – such as taking vitamin D and calcium supplements or keeping parts cool – should be part of this conversation, experts said. It is also essential for physicians to check with women who practice THM if the medication actually reduces their symptoms – and if not, clinicians should consider removing them.
"It's a balance. Every woman is different, "said Kotsopoulos. "But the risk of breast cancer is high, so they need to take a very serious approach."
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