Hormones and breast cancer
The relationship between the use of HRT and breast cancer is unclear and women with breast cancer or women at increased risk of breast cancer, should make decisions based on careful discussion of the potential risk factors involved.
The possible increased risk of breast cancer from HRT with combined oestrogen and progestin has to be balanced against any short-term or long-term benefits for individual women. These possible benefits include relieving the symptoms of menopause and reducing the risks of bowel cancer and osteoporosis. Large studies conducted in the US to confirm these risks and benefits have recently been reported1,2.
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Advice for women with breast cancer
There have been a number of studies looking at HRT and its possible benefits or risks for women with breast cancer. There is insufficient evidence to state that HRT is dangerous to women with breast cancer, but there may be some increase risk of breast cancer recurring or a new breast cancer developing with long term use. This risk may be outweighed by the immediate and potential long term benefits of HRT, in some cases.
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Making your decision
The following advice is provided to assist women with breast cancer or women at increased risk of breast cancer to make an informed decision about HRT, in discussion with their own doctor.
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Preventative use of HRT for women without menopausal symptoms
HRT is generally not recommended for women who do not have any menopausal symptoms. However, post menopausal women who have had breast cancer diagnosed may be treated with the drug Tamoxifen for up to 5 years. Tamoxifen is a hormone drug and has been widely and successfully used. As well as reducing the chance of breast cancer recurrence, this drug may also provide some protection against osteoporosis and the possibility of heart disease.
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The use of HRT for women with menopausal symptoms
Women, including those with breast cancer, may suffer from menopausal symptoms such as hot flushes that will interfere significantly with their day-to-day living. When making a decision about using HRT, the severity of a woman's symptoms and their impact on the woman's daily life must be balanced against the possible protective or damaging effects of HRT.
If you are experiencing menopausal symptoms you need to discuss the advantages and disadvantages of HRT with your own doctor and often a specialist. You may also like to discuss other treatments for individual symptoms like hot flushes.
Your decision about treatment may depend not only upon your symptoms but also on your own particular life circumstance, your beliefs about your health, your medical history and your family. To relieve menopausal symptoms HRT may need to be given for 1-10 years. However to reduce the risk of osteoporosis or bowel cancer HRT needs to be taken for longer. You should discuss this with your doctor. Some women choose to stop their HRT or reduce their doses after 1-5 years and see what happens. Your doctor may also advise you to try and 'wean' yourself off HRT after a few years.
As yet there are no results from well designed trials where women after breast cancer have volunteered to be randomly allocated to HRT or a dummy tablet (a placebo) and followed up for many years. However, there are now six studies of women who themselves choose to take HRT, and breast cancer recurrent rates in these women are less than in women who chose not to take HRT. This is reassuring but the studies are open to possible bias. Here are some helpful hints if you are having menopausal symptoms and are thinking about HRT:
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Talk with your GP, breast specialist, oncologist or gynaecologist about your symptoms and the benefits and risks of HRT. Seek further information and other opinions if you wish. Ask your doctor to refer you to other specialists. Read books on menopause and HRT, many of which are available from your local library. These are written for all women and contain some useful general information. You may also find that a local community health service or women's health service may have a library or information service that you can use.
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Take time with your decision. Only you can know how much your menopausal symptoms are affecting your daily life. In the end only you can make the decision about HRT.
If you decide to use HRT check with your doctor about whether you need to have more regular check-ups.
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Key points
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There is insufficient scientific evidence that HRT is either safe or dangerous for women with breast cancer. There is a possibility that HRT may increase the risk of breast cancer recurring or a new breast cancer developing. The immediate and long-term benefits of HRT may outweigh the risks. Decisions about HRT need to be made on an individual basis. HRT is generally not recommended as a prevention measure for women who have no menopausal symptoms.
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Making decisions about HRT can be difficult for many women; it may be even more difficult if you have had breast cancer or if you are at increased risk of breast cancer because your mother and/or sister developed breast cancer before menopause.
Unfortunately there are no clear cut recommendations about the use of HRT for women with breast cancer or at increased risk of breast cancer. This information sheet has been written to help you with any decisions you might want to make about HRT.
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