Earlier this year we commented on HRT medication in the blog Should my GP be offering HRT? In the last few days new research published from an Oxford University study has revealed that women receiving hormone replacement therapy (HRT) are at higher risk of developing breast cancer than previously thought.
Professor Valerie Beral who conducted the study at the University of Oxford states that “previous estimates of risks associated with use of menopausal hormone therapy are approximately doubled” due to the discovery that there is a persistent risk even after the woman ceases to use the hormone.
Menopause and Benefits of HRT
Menopause is when a woman stops having periods and is no longer able to get pregnant naturally. This process on average starts in women between the ages of 45 and 55.
HRT is used to treat the symptoms that can accompany this process, including hot flushes, night sweats, mood swings, vaginal dryness and reduced sex drive. HRT works by replacing the hormone oestrogen that your body stops producing when you go through the menopause.
What is the risk?
Research from Oxford University recently published (29 August 2019) in The Lancet found that for women between the ages of 50 and 59 who have not taken HRT the general risk of breast cancer is 6.3%. Whereas for women on oestrogen plus daily progestogen for five years, there is an 8.3% risk of breast cancer. This means that the risk of breast cancer is increased by a third when a woman takes HRT. As a result, 1 in 50 women using HRT will develop cancer that they would otherwise have avoided.
The research also highlights that the risk of developing breast cancer does not go away as soon as women stop taking HRT, as had previously been assumed. The presence and effects of HRT in the body continues at some level for 10 or more years after women stop taking HRT.
Furthermore, the longer women take HRT, the greater their risk of developing breast cancer will be. For women using HRT for 10 years compared to five years, the risk of breast cancer nearly doubled. As such, Professor Beral advises women who will continue to use HRT that they do so for as little amount of time as is possible. On a positive note, the paper also noted that those on the treatment for less than a year appeared to suffer no extra risk.
The form through which the HRT is administered was also found to impact the risk of breast cancer. HRT can be taken through pills, gels and patches for instance. Oestrogen therapies applied in the vagina, such as by a cream, were found to not increase the risk. However, these creams do not reach the bloodstream and circulate around the body. This means that they do not provide all the benefits and relief of symptoms like the pills or gels that increase the risk of breast cancer.
Assessing the risk
Multiple experts in the field of menopausal hormone therapy have validated the credentials of the research paper produced by the University of Oxford. Stephen Evans, Professor of Pharmacoepidemiology at the London School of Hygiene and Tropical Medicine (LSHTM), said “this is a ‘tour de force’ in what has been done and the way it has been done – the findings cannot be dismissed.” Therefore this research definitely deserves consideration when deciding whether or not to take HRT.
It is no new concept that the decision to use HRT by menopausal women involves the process of weighing up the benefits of the treatment against the risks of developing breast cancer. This new research indicates that when making these calculations, the risk to take in to account is higher than previously thought. Sarah Branch, the deputy director of the MHRA’s (Medicines and Healthcare products Regulatory Agency) vigilance and risk management of medicines division commented that “no medicine is completely without risk…” but “it is important for women to be able to make an informed decision about the risks and benefits that are appropriate for them.” This new research enables women to make more informed choices when deciding to use HRT or not.
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