A sweeping new analysis adds to the evidence that many women who take hormone therapy during menopause are more likely to develop breast cancer — and remain at higher risk of cancer for more than a decade after they stop taking the drugs.
The study, published Thursday in the Lancet, looked at data from dozens of studies, including long-term data on more than 100,000 women who developed breast cancer after menopause. Half of those women had used what’s known as menopausal hormone therapy, or MHT. The longer women took the medicine, the more likely they were to develop breast cancer. Experts say the findings could shape how women and their health care providers decide how to manage symptoms of menopause.
“This is a consensus of many researchers and many studies all around the world. These are important new results,” said said Valerie Beral, a cancer epidemiologist at the University of Oxford and one of the lead authors of the new study.
Women have long been prescribed synthetic versions to replace the hormones that decline during menopause. The medications — usually delivered in a pill, but sometimes in a patch, gel, or injection — provide women either estrogen or a combination of estrogen and progesterone. For many women, they help to tamp down symptoms of menopause, including osteoporosis.
For years, research has suggested a potential link between MHT and an increased risk of breast cancer. In 2002 and 2004, the Women’s Health Initiative released reports that showed women who used combination MHT were more likely to develop breast cancer. MHT use fell after the reports received widespread coverage. That was followed by a decline in breast cancer rates.
But there wasn’t much information on whether that risk persisted, or how it differed based on the type of MHT a woman took. So an international group of researchers pulled together data from dozens of studies — published and unpublished — to examine the issue more closely. They took a woman’s age at first use of MHT, how long she used the medication, and the time elapsed since she last used it into account. The mean age of women starting menopause was 50, which was also the mean age at which women started using MHT.
The researchers found that compared with women who never used MHT, women who did had a significantly higher risk of developing invasive breast cancer. They estimated that 6.3% of women who never used MHT developed breast cancer, compared to 8.3% of women who used the combination drug continually for five years. That’s roughly one extra cancer diagnosis for every 50 users.
The longer women used MHT, the greater their risk of breast cancer. Women who were no longer using MHT had a lower relative risk than women who were currently using it — but they remained at an elevated risk for more than a decade after they stopped taking the drug. The level of risk was dependent on how long a woman took MHT. The study also found that women who took the combination drug were more likely to develop cancer than women who took the estrogen-only drug.
“The findings are significant,” said Joanne Kotsopoulos, a breast cancer researcher at Women’s College Research Institute in Toronto. “The longer you use it, the higher the risk,” added Kotsopoulos, who wasn’t involved in the research but wrote a commentary on the study, also published in the Lancet.
The new analysis doesn’t show that MHT directly causes breast cancer. But researchers suspect the association has to do with the hormonal changes of menopause. The level of hormones produced by the ovaries dramatically drops during menopause. Going into menopause early is thought to lower the risk of breast cancer. But using MHT might keep women in something like a pre-menopausal state, keeping them from getting the protective benefits of menopause on cancer risk.
“Estrogens stimulate activity in the breast and increase the risk of breast cancer. [MHT] is just putting that stimulus, which had gone after menopause, back,” said Beral.
The caveat: The findings, broadly speaking, apply to women of average weight in developed countries. The researchers found that MHT didn’t have a significant adverse effect on women who were obese, though obesity is also a risk factor for breast cancer after menopause.
For now, experts say patients and providers should carefully consider when the potential benefit of using MHT outweighs the risks. Alternatives to MHT — like taking vitamin D and calcium supplements or keeping rooms cooler — should be a part of that conversation, experts said. It’s also critical for doctors to check in with women on MHT about whether the medication is actually easing their symptoms — and if it isn’t, clinicians should consider taking them off the drugs.
“It’s a balance. Every woman is different,” said Kotsopoulos. “But the risk is high for breast cancer, so they need to take a very serious approach.”
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Synthetic hormones are exactly the same as what was produced in ovaries. Yes, they are created in a lab, but the biological/chemical composition is identical. Not to be confused with “bio-identical” as provided (at great cost) by compounding pharmacies. Using horse urine (Premarin) doesn’t sound natural to me at all, and I believe this to be the mht used by many women in the research.
Yup~~~~I would say they are right. I was on an estrogen patch for 5 years ~~until I was 56~~~~when I was 65 I had breast cancer.
What if women remained on low dose bc (begun in the 20s) throughout menopausal years? Has anyone studied that? It would appear there would be a level dose of horomones and not the precipitous drop followed by HRT uptick that these studies seem to pinpoint as cancer catalyst.
This study is about synthetic hormones. It does not include bioidentical hormones. The difference is between the two is enormous.
Why would the doctor’s writing these prescriptions choose synthetic over natural bioidentical? Because the drug companies can’t get patents on nature!
Therefore they can’t make enormous profits! When the drug companies representatives, visit the doctor’s office, they are pushing the sale of synthetics and in some cases are offering incentives.
There is also a lack of expertise in the qualifications of the prescriber. Most have not had training in Hormone therapy and have had very little experience.
What is YOUR expertise? These hormone supplements are incredibly cheap. The so called “bioidenticals” are not cheap and make quite a lot of money for the compounding pharmacy and the charlatans who push them. There’s no difference in risk.
Please do some more research on the term “synthetic hormones.” They are not as bad as the name sounds.
Of course they get breast cancer. AMA does not balance the estrogen with the personalized amount of progesterone for your body and maintain that correct balance through regular testing. You cant just take estrogen, obviously. Medical persons trained in HRT know this and use competent compounding pharmacies to get safe results.
I’ve tried to get off of my estrogen pills, but I can’t survive the horrific hot flashes and sweating. I’m down to twice a week and on a much lower dose than my original daily pills and my current dose controls my discomfort during the day, although I sleep super super hot very often.
For awhile, I was down to once a week on that lower dose, but wasnt’ sure about it. I’ll try that again, now that I’ve read this article.
Bottom line is that when you can’t survive the day, it’s hard to worry about the future, and so I won’t be totally eliminating estrogen pills any time soon. Maybe I’ll try again in a year or so.
And yes, all women are different; no cancer in my family at all.
And I discuss this balance with my GYN each time I see her.
She thinks my present dose is fine. But that was before this new study.
I also take Vagifem brand vaginal estrogen 2/ce week which I know I can’t survive without — horrible vaginal pain developed a couple weeks after I stopped it — and so will have to be on forever. I just tried the gel capsule version of vaginal estrogen but I find it painful to insert and long after I insert it.
So, back to Vagifem, which fyi, I get from Canada and save a ton of money over my Rx insurance.
If you research Canada Rx firms, there is a difference among them. The one I chose has a bunch of certifications that I was looking for after researching Canada’s version of our FDA.
I also recently started Premarin cream – a drop near my vaginal opening twice/week. My GYN recommended that after another doc advised that it could help reduce pain due to atrophied skin — pain which vaginal pills can’t reach. But I’m not sure I notice a difference, and, given this article, am going to try stopping it.
Everything must be an individual balance. It’s really so hard when you have conflicting needs.
I’d like to know if the risk was elevated with non-systemic HRT use, ie, intravaginal. The article states that use was looked at across type of hormone, which I hoped looked at systemic (ie, oral) vs non-systemic. It is noted that estrogen only had a lower association than estrogen/progesterone but that’s as far as the breakdown in the article went.
@tw: The risk was low for topical vaginal estrogens – they say it in the Lancet article about this study: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31709-X/fulltext .
In regards to the use of HRT article, there is no mention of the risk for development of breast cancer for women who use a bio identical patches. Was there a breakdown of the types of HRT in the study?
They don’t mention bioidentical patches, but they did study various types of HRT. The Lancet article is available in open access: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31709-X/fulltext