In The Majority of Breast Cancers, Is HRT A Factor At All?   



In The Majority of Breast Cancers, Is HRT A Factor At All?

 
Breast cancer is the most common cancer in women in most parts of the world. It is the world leading cause of cancer deaths in majority countries. The incidence of breast cancer was estimated to be 35 cases per 100,000 of the female population in 2000. 

Ovarian hormones seem to play an important role in the development of breast cancer. Early onset of menstruation (before age 12), late menopause (after age 55), nulliparity (never having given birth to a baby) and late age of first childbirth (after age 30) appear to be contributing risk factors for breast cancer. 

Risk in perspective

The use of oral contraceptives and hormone replacement therapy (HRT) may also increase the risk of breast cancer. Overall, epidemiological studies suggest that the use of HRT for less than five years does not increase the risk of breast cancer. It is the long-term use of HRT that has recently been associated with an elevated risk of breast cancer. 

Considering two groups of 10,000 women, one on long-term HRT and one a group of non-users, a recent study found 30 cases of invasive breast cancer in non-users, compared to 38 cases in HRT users. This shows an increase of 8 cases of invasive breast cancer per year more in a group of 10,000 women on long term HRT. In other words, the increased risk of breast cancer applied to an entire population of women, as opposed to individual women, is very small, or less than a tenth of 1 per cent per year. 

It is important to emphasize that breast cancer risk increases with duration of usage, and is only significant after 5 years of HRT use.

Breast surgeon always advise women that the risk is there, but it is a small risk. 

Other considerations

While HRT users may face a small increase in the risk of breast cancer, they are advantaged in other respects. 

Women on HRT are more frequently monitored, especially if they do develop breast cancer, it is more likely that it will be detected at an early, treatable stage. If breast cancer develops while the woman is on HRT, it is also more likely to be well differentiated and have better prognostic factors. 

Breast cancers diagnosed in HRT users are smaller and less likely to have spread to the axillary lymph nodes. This can be attributed to regular follow-ups and mammograms done every one to two years.

All of this leads to a better survival in a woman who develops breast cancer while on HRT. 

HRT is often not prescribed to women with a family history of breast cancer, or those who currently have breast cancer.

However, even that may be controversial now, citing a study, which suggested that women with a family history of breast cancer and who took HRT did not show an increased incidence of breast cancer compared to those who were not. 

Making the choice

HRT is definitely about improving the quality of life.

There are no substitutes for the relief HRT provides on menopausal symptoms such as hot flushes, mood swings, depression, insomnia, dry skin, loss of libido and loss of vaginal secretions. But some women may go through menopause without all of these problems, and some of them may feel worse on HRT. If HRT does not improve the quality of life, or makes them worry about their risks, then a woman should not go on it.  

When the time comes, it has no qualms about going for HRT. Many women on HRT who are looking better and younger. 

In addition, a recent study conducted on breast cancer patients, found that 97 per cent of them were not on HRT at the time of diagnosis. 

This shows that in the majority of breast cancers, HRT may not be a factor at all. And, if they are diligent about their mammograms and checkups, any signs of cancer can be picked up early.

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Happy reading,
Evelyn


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