This week a key talking point in all the press has been the Breast Cancer Now Generations Study on HRT use and breast cancer risk as published in the British Journal of Cancer. When many of these studies are published concern and alarm can be raised by evocative headlines when in fact a more balanced and considered approach is the best way to gather the actual facts.
The key talking point of the report was the associated links to breast cancer from the use of combined HRT treatment (those taking both oestrogen plus progestogen). However, it is important to stress that there are no new findings in this report and for all treatments a broader approach must also be considered that include lifestyle factors, i.e. general fitness, weight, if a woman is a smoker and their alcohol intake, all of which can be managed.
So to arm you with the facts the Royal College of Obstetricians and Gynaecologists (RCOG) shared the following with all members this week:
- The risk associated with combined HRT returned back to baseline within 1 to 2 years after stopping HRT, confirming the view that HRT does not CAUSE breast cancer, but that it may promote the growth of cancer cells which are already present in some women. It can act as a promoter, not an initiator. This is a really important message since many women fear that HRT causes breast cancer
- The NICE guideline (which is the guideline that covers the diagnosis and management of menopause) did take into account the fact that previous observational studies may have underestimated the risk, so NICE recommendations are still very relevant
- No increased risk with oestrogen only
- In combined HRT, there is evidence that different progestogens may be associated with a different risk, types increasingly used today were not the main types used in this study
- While trebling of risk sounds very alarming, the actual figures are still very small and for many women, the benefits will continue to outweigh the risks
Dr Heather Currie, spokesperson for the Royal College of Obstetricians and Gynaecologists (RCOG) and Chair of the British Menopause Society (BMS), said:
“The findings of this prospective study reconfirm that some previous studies may have underestimated the risk of breast cancer associated with combined oestrogen-progestogen HRT use. Similar to the evidence base considered within the recently published NICE guidelines on menopause, women using combined HRT are at an increased risk of developing breast cancer depending on the duration of use, although this risk reduces once HRT use stops. Further clarity around the effects of different types and routes of progestogens in combined HRT is needed. In women using oestrogen-only HRT, there was no overall increase seen in breast cancer risk compared with women who had never used HRT.”
“HRT is an effective treatment for menopausal symptoms, particularly with the management of hot flushes. However, the risks and benefits are different for each woman, depending on her own medical history, her family history and her menopausal symptoms. To take or not to take HRT, or other treatments for menopausal symptoms, is an individual choice.”
In addition, HRT has been lauded in the treatment of cardio vascular disease, dementia and osteoporosis. Here at the Scotia Clinic we take an evidence-based approach when deciding upon the best course of treatment for any of our patients going through menopause in addition to their lifestyle factors, their medical and family history.
As with any report the best course of action is to speak to your GP, talk to us here at the Scotia Clinic or with the medical practioner you first commenced your treatment with. It is imperative to stress that no one should stop any treatment until they speak to their GP or chat to us here at the Scotia Clinic if any concerns have been raised for you by this report. Equally it’s important to note that for the majority of women who seek treatment for menopause they go on to enjoy a wonderful quality of life with the benefits of treatment.
Dr. Mary McCaffrey
Medical Director, Scotia Clinic, MB FRCOG, Consultant Obstetrician – Gynaecologist
Scotiaclinic.ie
