February 2002 Update
A 2002 article in JAMA reported a possible connection between HRT and a type of breast cancer called lobular carcinoma. This cancer occurs in the lobules of the breast. The more common ductal cancers occur in the milk ducts. Due to their location in the breast, lobular carcinomas may be more difficult to feel during breast exams. They also may be harder to find with mammograms.
The study done in Seattle compared 705 postmenopausal breast cancer patients with 692 women who had never had breast cancer. The study showed that recent, long-term use of HRT was associated with an increased risk of breast cancer. Longer use of HRT and current use of combination HRT were associated with an increased risk of lobular breast cancer.
There are some concerns with this study. The women with breast cancer were more likely to have a family history of breast cancer than the healthy women in the control group. In fact, 135 of the breast cancer patients had a parent, sibling, or child who had breast cancer. Only 88 of the controls did. The breast cancer patients were also more likely to have a grandparent, aunt, uncle, or grandchild who had breast cancer. A family history of breast cancer is a risk factor for breast cancer. So this finding raises concern.
Also, the vast majority of women taking HRT did not develop breast cancer. It would have been helpful if this study had shown how many patients versus controls developed bone breaks, dementia, heart disease, or experienced menopausal symptoms.
So how do women decide about HRT/ERT? The best way to proceed is to map out your family history of cancer and other diseases. That should include breast, ovarian, colon and pancreatic cancer. It should also include osteoporosis and heart disease. Also, research your own personal risk factors for breast cancer, osteoporosis, and heart disease. Then consider the menopausal symptoms that are associated with hormone loss. They include:
- hot flashes
- vaginal dryness
- changes in sexual functioning
- changes in skin quality
- memory loss
Sit down with your doctor and map out the pros and cons of HRT/ERT for you. And, prepare to be flexible. The data in this area are constantly evolving.
References
Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA 2002;288:321–33
Anderson GL et all: Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial, JAMA. 2004 Apr 14;291(14):1769-71