Potential Risk factor | Breast Cancer Associate With HRT Higher Than imagination

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Hormone replacement therapy (HRT) with a combination of estrogen and progestogen (although not HRT with estrogen alone) increases the risk of breast cancer to a much greater extent than has previously been reported, and the longer the duration of use, the greater the risk, new research shows.


"Our research shows that some previous studies are likely to have underestimated the risk of breast cancer with combined oestrogen-progestogen HRT," senior author, Anthony J. Swerdlow, MD, professor of epidemiology, the Institute of Cancer Research (ICR), London, United Kingdom (UK), said in a statement.

"We found that current use of combined HRT increases the risk of breast cancer by up to threefold, depending on how long HRT has been used," he reported.
The new findings are published in the British Journal of Cancer and made headline news in the United Kingdom.
Breast Cancer Risk
The increased risk for breast cancer with combination HRT was first reported in 2002 from the Women's Health Initiative and in 2003 from the Million Women study, and at the time, the news led to a dramatic fall in the use of HRT. Since then, however, some more recent studies have suggested there is no increase, or little increase, in breast cancer risk.
In the latest guidelines on managing women's overall midlife health from the International Menopause Society, issued earlier this month, the authors state that the risk for breast cancer attributable to combination HRT is less than 1 per 1000 women per year of use, a risk that is similar to or lower than that seen with such lifestyle factors as obesity and alcohol consumption.
However, the UK researchers of the latest report argue that investigators in previous studies failed to use follow-up questionnaires to update HRT status or duration of use up to the point of diagnosis of breast cancer, as they themselves did.
"Without such follow-up information...we found that the excess breast cancer risk for combined MHT [menopausal hormone therapy] would be underestimated by ~53%," they note.
To arrive at the new estimates of HRT-attributable breast cancer risk, the UK researchers collected information from serial questionnaires administered to the Breakthrough Generations Study cohort to ascertain HRT use and menopausal status at study entry and during prospective follow-up.
"The first follow-up questionnaire was completed at 2.5 years after recruitment, a second at ~6 years, and a third at 9.5 years," the team writes.
On recruitment to the study, women had used estrogen-only HRT for a median of 6.5 years, while women taking the combination of estrogen plus progestogen had done so for a median of 5.5 years. For other types of HRT (over half of which was tibolone), the median duration of use was 4.5 years.
Almost two-thirds of women who were using HRT when they entered the study stopped taking it later on.
During a median follow-up of 6 years, 775 invasive or in situ breast cancers were identified among 39,183 women whose age at menopause was known.


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