HRT is also prescribed to help reduce a woman's risk of heart disease and to help her bones stay healthy and free of debilitating osteoporosis.
However, these marvelous benefits do not come without some risk including increased risk of certain cancers.
Physicians often prescribe estrogen plus progestin to postmenopausal women who have not had a hysterectomy. Progestin is added to help protect the uterus from the increased risk of endometrial cancer associated with estrogen only therapy. However the effect this combination had on breast cancer risk has been unknown.
Now, the American Medical Association says that women who use estrogen/progestin combined for postmenopausal symptoms face a 20% greater risk of breast cancer compared with women who use estrogen only.
In the January 26, 2000 issue of the Journal of the American Medical Association the results of a cohort study of follow-up data for 1980-1995 from the Breast Cancer Detection Demonstration Project, a nationwide breast cancer screening program, were revealed.
Over 46, 000 women whose average age was 58 at the start of the study were included. The women were screened at twenty-nine centers throughout the United States. During the follow-up breast cancer was identified in 2082 of the women. Increased breast cancer risk associated with estrogen or estrogen/progestin combination was restricted to women who had used these hormones within the last four years.
The relative risk in women who, either currently or within the last four years, used combined estrogen/progestin therapy was 1.4; women who used estrogen alone had a relative risk of 1.2. The risk of breast cancer increased with each year that a woman took HRT (estrogen by .01 and estrogen/progestin by .08). Women whose body mass index (BMI) was 24.4 kg per meter squared or less were at slightly increased risk compared with women who were heavier.
Does this mean that women who take combined estrogen/progestin therapy should stop? Not necessarily. But, it does mean that each women together with her physician should carefully reevaluate her personal risks against the overall benefits of menopausal hormone replacement therapy (HRT). According to the article, "Our results, as well as those of others, suggest that in weighing the risks and benefits of menopausal HRT, it is important to consider the type of hormone regimen as well as individual characteristics of the woman, such as body mass index."
The full article from JAMA (subscription required)
Postmenopausal Estrogens- Opposed, Unopposed or None of the Above JAMA editorial by Walter C. Willett, MD, DrPH; Graham Colditz, MD, DrPH; and Meir Stampfer, MD, DrPH (subscription required)
More About this story in the News
Estrogen-Progestin Replacement Therapy Increases Breast Cancer Risk From the American Cancer Society
Estrogen/Progestin HRT Seems to Increase Risk of Breast Cancer Doctor's Guide
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