In The Majority of Breast Cancers, Is HRT A Factor At All?
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
Breast surgeon always advise women that the risk is there, but
it is a small risk.
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
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