Hormone Replacement Therapy (HRT) and Breast Cancer Risk
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OCTOBER IS NATIONAL BREAST CANCER
HORMONE REPLACEMENT THERAPY (HRT)
AND BREAST CANCER RISK
The rising incidence of breast cancer, year-after-year, over the past 50 years in the United States (and in many other industrialized countries) has been attributed to a variety of factors, including environmental contaminants, rising obesity levels, and increased compliance with annual screening mammograms, among others. However, one factor that has been given inadequate attention, in my view, is that of hormone replacement therapy (HRT), despite nearly a century of data showing a strong linkage between lifetime exposure to the female hormones estrogen and progesterone and the risk of developing breast cancer.
In 2002, the enormous, randomized, prospective, blinded Women’s Health Initiative (WHI) study published its preliminary results, and prematurely terminated its combination HRT study because of an alarming increase in the incidence of breast cancer in the group of women who had been secretly randomized to receive combination HRT medications for menopausal symptoms.
Despite subsequent updates from the WHI, which have shown, essentially, a doubling of breast cancer risk after more than 5 years of HRT use, there was initially a great deal of resistance to the WHI’s findings (and the findings of other similar clinical research trials) linking HRT use with an increased risk of developing breast cancer.
Now, a new national Canadian public health study offers additional powerful clinical research data linking HRT use with breast cancer risk, and reveals the equally strong link between declining HRT use and the declining breast cancer incidence in Canada. This study appears in the current issue of the Journal of the National Cancer Institute.
In this study, 1,200 women between the ages of 50 and 69 participated in the National Population Health Survey between 1996 and 2006. Just prior to the 2002 release of the WHI study’s results, 13 percent of these women regularly used combination HRT. By December 2004, only 5 percent of the postmenopausal women participating in this study were still taking HRT medications. During this same period, the incidence of breast cancer in this large group of Canadian women decreased by about 10 percent. (Importantly, compliances rates with screening mammograms did not change during the course of this clinical research study.)
Thus, between 2002 and 2004, when HRT use significantly declined, the incidence of breast cancer decreased by about 10 percent in Canada. Moreover, this significant decrease in breast cancer incidence occurred without any change in mammogram rates.
This study, as with other recent studies, adds to the overwhelming research data linking HRT use with an increased risk of developing breast cancer. As I tell my own patients who are approaching menopause, it is best to avoid HRT altogether. If you are already taking HRT medications, then ask your doctor to help you in weaning yourself off of these medications.
In recognition of Breast Cancer Awareness Month, I urge our tens of thousands of regular Weekly Health Update readers to join in the global fight against breast cancer. There are numerous organizations and groups, in virtually every community, that are sponsoring fundraising activities throughout October, including the Susan G. Komen Race for the Cure. Another opportunity to participate (and at no cost!) is to vote for the Dr. Susan Love Research Foundation Army of Women project in the Pepsi Refresh competition! There are also many other worthwhile and deserving fundraising programs available for everyone to become involved in!
For a deeper evidence-based discussion of the links between HRT and breast cancer risk, order your copy of my new book, “A Cancer Prevention Guide for the Human Race,” from Amazon, Barnes & Noble, Books-A-Million, Vroman’s Bookstore, and other fine bookstores!
Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity
Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author
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