This week I will address hormone replacement therapy (HRT) and the myth that HRT causes breast cancer. We will dive deep into what the current research says and provide a clear-cut answer to this misconception related to HRT. So let’s dive in!
Let’s first address why one would be started on HRT. According to Woo and Robinson (2019), it “may be instituted any time there is a loss of the body’s ability to produce estrogen and progestin,” commonly seen in the menopausal female (p. 1151). At the time of menopause, women lose the ability to produce hormones which is why we would take HRT. This treatment consists of providing the individual with estrogen, progesterone, or both to aid in managing postmenopausal symptoms (Harper-Harrison & Shanahan, 2023).
The Mayo Clinic (2022) shares that HRT aids in reducing common symptoms associated with menopause, which include hot flashes, night sweats, anxiety, mood changes, chills, dryness /itchiness /burning/discomfort with intercourse, joint pain, and bone loss or thinning to name a few.
Okay, so now we understand why we would take HRT but why would I take this medication if it increases my risk of developing breast cancer?
Because of the misconception of like this, “only a minority of women seek help to manage symptoms, often because they do not know who to approach or because misinformation has led to fear of treatment” (Rymer et al., 2019, p. 1). Let's look at the data now. Again, in the study completed by Rymer et al. (2019), it was observed that the risk of developing breast cancer when taking HRT is as follows:
- Estrogen-only HRT – 1:200
- Sequential HRT – 1:70
- Continuous combined HRT – 1:50
Essentially, this shows that different forms of HRT, especially those that include progesterone, slightly increase the risk of developing breast cancer. With that being said, I think it is important to emphasize that lifestyle habits and factors, such as drinking alcohol or being obese, increase the risk of breast cancer more than HRT. In fact, an individual who is overweight or obese has a six times higher risk of getting breast cancer compared to a healthy individual who takes HRT (Rymer et al., 2019).
“Fear of HRT among women, and misunderstanding of the risk/benefit along with the lack of appropriate education among providers, has led to underutilization, unnecessary suffering, and excess chronic disease and mortality in postmenopausal women over the past two decades” (Langer et al., 2021).
Need more? Another study by Langer et al. (2021) reports that the majority of studies conducted on the relationship between HRT and breast cancer have been observational leading to more false and biased reflections. They dove into the clinical studies being conducted and found that although there were individuals who developed breast cancer after starting HRT, the results were not significant. Additionally, they address that the form of HRT plays a large impact on the risks of developing breast cancer. In other words, studies have shown that the more progesterone in the HRT plan the higher the risk (Langer et al., 2021).
I am not here to tell you that there is not a risk association between HRT and breast cancer. But I am here to tell you that those risks are low and there are a number of different factors that can also play a role in the development of breast cancer that we also have control over. If you are someone who is or will be experiencing menopause, please reach out to your doctor and have a discussion about HRT. Continue to educate yourself, you might find that HRT is just what you need to feel like the best version of you again!
References
Harper-Harrison, G. & Shanahan, M. M. Hormone Replacement Therapy. [Updated 2023 Feb 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Available from:https://www.ncbi.nlm.nih.gov/books/NBK493191/
Langer, R. D., Hodis, H. N., Lobo, R. A., & Allison, M. A. (2021). Hormone replacement therapy–where are we now?. Climacteric, 24(1), 3-10. https://doi.org/10.1080/13697137.2020.1851183
Mayo Clinic. (2022, December 6). Hormone therapy: Is it right for you? Retrieved from https://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-therapy/art-20046372
Moser Woo, T, & Robinson, M. (2019). Pharmacotherapeutics for Advanced Practice Nurse Prescribers (5th). F.A. Davis Company. ISBN-13: 978-0-8036-6926-0
Rymer, J., Brian, K., & Regan, L. (2019). HRT and breast cancer risk. British Medical Journal, 367, 1-2. https://doi.org/10,1136/bmj.I5928
Taylor,
ReplyDeleteI also researched HRT and its relationship to breast cancer. I found similar results. I like how you stated there are other modifiable lifestyle factors that could contribute to the development of breast cancer. Johns Hopkins Medicine (2023) states early detection is directly correlated to increased survival rates. Early detection can start with self-examinations to become familiar with your individual breast tissue to help determine changes that could cause concern for breast cancer (National Breast Cancer Foundation, Inc., 2022). Great work, Taylor!
-Anna
References
Johns Hopkins Medicine. (2023). Breast cancer awareness: Infographic. https://www.hopkinsmedicine.org/health/conditions-and-diseases/breast-cancer/breast-cancer-awareness-infographic
National Breast Cancer Foundation, Inc. (2022). Breast self-exam. https://www.nationalbreastcancer.org/breast-self-exam/
Taylor-
ReplyDeleteYour post is so informative, and I really enjoyed reading all the statistics in it. I am a numbers person and seeing the numbers really puts stuff into perspective. Faubion et al. (2022) backs your statement that there is no risk associated between HRT and breast cancer. Their statics puts it at less than 1% out of 1,000. When searching for articles I found one by Urgas and Rahman (2021) that talks about controlling symptoms of breast cancer survivors. In this article they talk about tissue-selective estrogen complex therapy. I found this super interesting! If they can use estrogen to create a tissue specific effect, I think we are on the right track for safely giving all women the option to use HRT, despite some major past medical history. Great post!
References
Faubion, S. S., Crandall, C. J., Davis, L., El Khoudary, S. R., Hodis, H. N., Lobo, R. A., & Wolfman, W. (2022). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause, 29(7), 767-794. https://doi.org/10.1097/GME.0000000000002028
Ugras, S. K., & Rahman, R. L. (2021). Hormone replacement therapy after breast cancer: yes, no or maybe?. Molecular and Cellular Endocrinology, 5(25), 111180. https://doi.org/10.1016/j.mce.2021.111180