Breast Cancer Risk, Prevention Strategies, and Alternative Approaches Associated with Hormone Therapy
In the realm of menopausal healthcare, understanding the potential risks and benefits of combined hormone therapy (HT) – specifically, estrogen plus progestogen – is crucial. Here's a breakdown of the relationship between combined HT and breast cancer risk.
Combined HT increases the risk of developing breast cancer, with the risk rising as the duration of use increases. This risk is highest during current or recent use. However, it's important to note that the relative risk increase is small but significant, especially when compared to estrogen-only therapy. For instance, among 10,000 women in their 50s, about 9 additional breast cancer cases per year could be linked to recent combined HRT use for less than 5 years.
The risk is higher with longer durations of use (over 5 years) and varies by the type of progestogen used. For example, norethisterone-containing preparations have a higher associated risk, while dydrogesterone-containing HRT has a lower risk.
On the other hand, estrogen-only therapy, which is generally prescribed for women without a uterus, may actually reduce the risk of breast cancer in younger women (under 55 years). On the contrary, combined estrogen-progestin therapy increases the risk.
After discontinuing combined HT, the excess risk diminishes over time, reaching approximately the baseline breast cancer risk level after about 5 years of cessation.
This evidence supports personalised HT decisions, considering individual risk factors and duration of therapy. If a person has a high risk of developing breast cancer, an oncologist may prescribe medications such as tamoxifen and raloxifene.
It's also worth mentioning that a lower-dose formula of HT may help reduce the risk compared with a higher dose. Getting enough physical activity or exercise, maintaining a moderate weight, and consuming a balanced diet can also help reduce the risk of developing breast cancer.
Avoiding alcohol or limiting intake, as well as current research suggesting that HT may help protect against cardiovascular disease if a person has no increased cardiovascular disease at the start of HT, are other factors to consider.
However, it's essential to note that there are no guidelines on the safety of HT use in those with a family history of breast cancer. It is best to talk with a doctor if a person has had breast cancer or an increased risk of the condition before considering HT.
In some cases, over-the-counter and prescription products to treat vaginal dryness or discomfort, such as vaginal lubricants, can be used as alternatives to HT.
Lastly, it's important to remember that every individual's situation is unique, and a personalised approach to menopausal healthcare is key. Consulting with a healthcare professional is the best way to make informed decisions about your health and wellbeing.
- Combined hormone therapy, consisting of estrogen and progestogen, increases the risk of developing breast cancer, and the risk escalates with longer usage durations.
- The risk of breast cancer is highest during current or recent use of combined HT, but the relative risk increase remains small but significant when compared to estrogen-only therapy.
- For women without a uterus, estrogen-only therapy may decrease the risk of breast cancer in younger women (under 55 years), whereas combined estrogen-progestin therapy enhances the risk.
- After discontinuing combined HT, the increased breast cancer risk diminishes over time, reaching similar levels to the baseline breast cancer risk approximately 5 years after cessation.
- Individual risk factors and duration of therapy should be considered when making personalized decisions about combined HT, and individuals at a high risk of breast cancer may be prescribed medications like tamoxifen and raloxifene.
- Lower-dose formulas of HT and lifestyle factors such as physical activity, moderate weight, and balanced diet can potentially help reduce the risk of breast cancer.
- Women with a family history of breast cancer or those who have had breast cancer should consult with a healthcare professional before considering HT, as guidelines on its safety in these cases are not established.
