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In discussing the concerns of Menopausal Hormone Therapy (MHT) with patients in the office, it’s evident that ‘the fear’ of developing breast cancer from hormone use, by far outweighs the benefits of use, for many women. With breast cancer being the number one cancer diagnosed among US women, and the second leading cause of cancer-related deaths (second to lung cancer,) those concerns are certainly understandable.
Though concern for an association of breast cancer from hormone use have perplexed patients and the medical community for many years, in the last 10 years, that level of concern has escalated to nearly a level of fear. Despite some public perception of hormones as the cause of breast cancer, the medical evidence does not support hormones as a cause for breast cancer. Unlike the causal link between smoking and most cases of lung cancer, a causal link between hormone use and breast cancer has not been established. In fact, the cause of breast cancer is still unknown.
This evolving change in public perception of hormone risks, is due in great extent, to the results of a widely published (and media covered) research study on hormones, the Women’s Health Initiative, 2002.
Prior to 2002, doctors were recommending MHT not only for it’s well established benefits in the treatment of the vasomotor symptoms (hot flashes, sleep disturbance, mood swings) of menopause, but also for the prevention of cardiovascular disease (based on results of observational research studies, which were applicable at that time.) The WHI, a NIH supported study, was a randomized trial, which set out to establish the clarity of the recommendation for hormones in the prevention of cardiovascular disease, as well as to establish the health risks versus benefits of hormone therapy in the prevention of many other chronic diseases.
While it would be true to state that the results of this study did show a slight increased risk of breast cancer for (Estrogen-Progesterone) hormone users over non-hormone users (by a factor of 8 additional cases/10,000 women), ‘grabby’ headlines like “Hormone use Increases Breast Cancer Risk”, may disallow the opportunity to put these (fractional) risk into perspective. Furthermore, important caveats from the study, such as duration of use, the study of a single Estrogen-Progesterone formulation and single dose, as well as the fact that Estrogen use alone (in women with previous hysterectomy) showed NO increased risk of breast cancer…were also equally important messages, that seem to get lost in the sensationalism of the leading headlines
The WHI is a landmark study that has changed the arena of hormone use, as well as, the counseling and prescribing patterns of many healthcare professionals. The results of this study must still be weighed against the benefits of hormone therapy for the many women who may suffer from significant symptoms of the menopausal transition, and its effect on their quality of life. Many professional medical associations have not recommended against hormone use, but rather adopted an anthem of “lowest dose for shortest duration” of therapy.
Let’s caution ourselves against being ‘swept away’ by headlines. Rely on your healthcare providers, in helping you to put the risk vs benefits of your individual healthcare choices, into perspective.
Suzanne Hall, MD (@drsuzyyhall)
Eastside Gynecology Obstetrics, PC