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In the realm of women's health, Hormone Replacement Therapy (HRT) has long been a subject of both curiosity and concern. It's a topic that has sparked numerous conversations among women navigating menopause and seeking relief from its associated challenges. One of the most pressing concerns has been the potential link between HRT and breast cancer. 

In this article, we engage in a comprehensive insights and evidence-based perspectives on the intricate relationship between HRT and breast cancer risk and the evidence from a recent article on risk of breast cancer and HRT use.  

HRT and breast cancer risk - Recent research in the British Medical Journal (BMJ)? 

A study published in the BMJ in 2020 which had almost 99,000 women between the ages of 50 and 79 as participants, was conducted to address the growing concern between HRT use and the risk of breast cancer. Numerous small observational studies were conducted in the past with confusing results. This study has provided evidence of a more generalizable indication of breast cancer risk for women on HRT. Women considering hormone replacement therapy (HRT) for menopause symptoms can find reassurance regarding the risk of breast cancer from recent research. 

When is HRT used? 

Menopause symptoms like hot flushes, vaginal dryness, mood swings etc., can be significantly distressing for many women, and HRT can offer life-changing relief. However, recent concerns arose when another study reported a higher-than-expected breast cancer risk associated with HRT.  This latest extensive study provides comforting results, aligning with existing evidence that HRT risks are generally low. 

What are the findings of the new study? 

Breast cancer risk, according to the BMJ study, was dependent on the type of HRT, duration of use and age of the woman.  

When it comes to the type of HRT, the study shows that breast cancer risks were found to be extremely low when using estrogen-only HRT. But it's essential to note that this form of HRT is suitable only for women who have undergone a hysterectomy.  

Most post-menopausal women opt for combined HRT, which contains both estrogen and progestogen, called combined HRT. In such cases, there was a small but definite increase in cancer risk but was associated with greater age (>60 years), duration of treatment (> 5years) and the type of progesterone used in the combined formulation.  

Here it is important to note that the researchers also identified an increased risk of breast cancer in post-menopausal women who had never taken HRT. For example, consider a group of 10,000 women in their 50s who have never used HRT. Among them, 26 women would develop breast cancer within a year. Now, if all 10,000 women had recently taken combined HRT for a duration of less than 5 years, the number of breast cancer cases would increase to 35. So, within this substantial group, the association with HRT results in an additional 9 cases of breast cancer per year. To put it into perspective, this translates to less than one in a thousand women. 

Are women who take HRT for a long time more prone to developing breast cancer? 

The BMJ study indicated that there was no increase in risk of breast cancer for those using HRT for less than a year. However, the risks increased with the duration of HRT treatment, especially when taken for more than five years. It was encouraging to note that the risks declined after discontinuation of HRT, with no increased breast cancer risk observed five years after stopping for women who had used combined HRT for less than five years. 

Does age play a role in breast cancer risk? 

Age definitely plays a role. The study showed that women in their 50s exhibited lower risk compared to those in their 60s and 70s.  

Was there evidence of a link between the type of progestogen used in combined HRT and breast cancer risk? 

Yes, the type of progestogen used in combined HRT had varying impacts, with norethisterone associated with the highest increase in breast cancer risk and dydrogesterone linked to the lowest risk. 

Why are the results of this study so important and relevant? 

This study supports the results found in other smaller, observational studies and provides reassurance to the thousands of women who are confused about their HRT treatment and the risk of breast cancer. The research clarifies the type of HRT and age of prescription along with the choice of progestogen that can keep breast cancer risk to a minimum. It indicated that HRT is generally associated with only slight increases in breast cancer risk. The findings of this study can serve as valuable guidance for discussions between healthcare professionals and women considering HRT. 

What would be the next steps you would recommend for post-menopausal women who want to explore HRT treatment? 

Engaging in a thorough discussion with your gynecologist regarding your menopause-related symptoms is crucial. This conversation should delve into finding the most suitable form of HRT for your specific requirements, taking your age into careful consideration. By doing so, you can minimize the potential risk of breast cancer. 

Moreover, it's essential not to underestimate the significance of breast self-examinations and regular cancer screenings. These proactive measures play a pivotal role in early cancer detection, which can be pivotal for effective treatment and improved outcomes. 

Dr. Sonal Dhande

DNB DNB

MOC Cancer Care & Research Centre, Nashik.