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The new analysis doesnt show that MHT directly causes breast cancer. But researchers suspect the association has to do with the hormonal changes of menopause. The level of hormones produced by the ovaries dramatically drops during menopause. Going into menopause early is thought to lower the risk of breast cancer. But using MHT might keep women in something like a pre-menopausal state, keeping them from getting the protective benefits of menopause on cancer risk.
Estrogens stimulate activity in the breast and increase the risk of breast cancer. is just putting that stimulus, which had gone after menopause, back, said Beral.
The caveat: The findings, broadly speaking, apply to women of average weight in developed countries. The researchers found that MHT didnt have a significant adverse effect on women who were obese, though obesity is also a risk factor for breast cancer after menopause.
For now, experts say patients and providers should carefully consider when the potential benefit of using MHT outweighs the risks. Alternatives to MHT like taking vitamin D and calcium supplements or keeping rooms cooler should be a part of that conversation, experts said. Its also critical for doctors to check in with women on MHT about whether the medication is actually easing their symptoms and if it isnt, clinicians should consider taking them off the drugs.
Understanding Menopause Hormone Therapy
Research on better and safer hormone therapy for menopause symptoms is constantly being generated. A new SERM type drug and estrogen combination are currently under clinical review by the FDA for the treatment of menopausal vasomotor symptoms and vaginal atrophy.However, women will have to wait until long term studies are done to know if this or any other new drug increases the risk of breast cancer, stroke or heart disease since the FDA only requires studies of two to three months to approve new drugs to treat hot flashes. Steroid administration is also under consideration as an alternative to HT. Tibolone, a synthetic steroid, is used in over 90 countries to treat menopausal vasomotor symptoms and improve bone density. However, Tibolone is not approved for use in the United States. While evidence on Tibolones risk for increasing the incidence of breast cancer is conflicting, it is currently contraindicated for use in breast cancer survivors, as Tibolone may lead to a relapse of breast cancer.Another hormone, testosterone, commonly known as the male hormone, is being tested to alleviate common menopausal complaints. The safety of testosterone has not been established. Among the concerns is the risk of breast cancer, since testosterone can be converted by a process known as aromatization into estrogen. Acne and facial hair growth are other side effects of testosterone.
Why Do Breast Cancer Cells Turn Into Cancer Cells
Normal breast cells become cancer because of changes in DNA. DNA is the chemical in our cells that makes up our genes. Genes have the instructions for how our cells function. Some DNA mutations are inherited or passed to you from your parents. This means the mutations are in all your cells when you are born.
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Strengths And Weaknesses In Relation To Other Studies
Our study used a nested case-control design, so it did not follow women prospectively from the start of HRT or assess average lifetime risks. Rather, it looked back at already recorded exposures to HRT for women with a diagnosis of breast cancer and matched controls in the age range 50 to 79 and produced comparisons of risks averaged across all time points at which diagnoses in the datasets occurred. The study is based on data derived from real world treatment settings, when women might not have had a constant supply of a preparation and might have needed to switch drugs during the study period. Including all exposures prescribed over time allowed us to present information for a wide range of common types of HRT.
Most trials produced results for a more restricted number of treatments. A meta-analysis of existing trials,7 taken largely from the Womens Health Initiative study, provided estimates only for the specific treatments of conjugated equine oestrogen with and without medroxyprogesterone.6 In contrast to our estimates of a slightly increased risk for long term users of conjugated equine oestrogen , the meta-analysis found no difference in risk of breast cancer after a mean duration of 7.2 years. The observed relative risk for the combined conjugated equine oestrogen with medroxyprogesterone therapy after a mean duration of 5.6 years was similar to our findings for recent exposure, with an average duration of 3.7 years .
Can Oral Contraceptives Increase Breast Cancer
There is a small transient increase in the relative risk of breast cancer among users of oral contraceptives but, since use typically occurs at young ages when breast cancer is relatively rare, such an increase would have little effect on overall incidence rates. In contrast, exposure to menopause hormone treatment occurs when the baseline risk
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Can A Person Lower Their Breast Cancer Risk
If a person decides to take HRT, they can ask for a lower-dose formula. They can also discuss with a doctor how to take it for the shortest possible time.
BreastCancer.org notes that a person can take certain steps to reduce their risk of developing breast cancer whether they use HRT or not.
They recommend that a person:
- exercise regularly
- quit smoking, if applicable
- limit their intake of alcohol
It is also important to achieve and maintain a healthy weight. This is because having more fat tissue can raise a persons estrogen levels, and as a result,
Menopausal Hormone Therapy Use Definition
MHT use was defined as use for at least three months of any type of MHT, including EPT and ET. Current MHT use was defined as use at, or within the six months prior to the reference date. Former MHT use was defined as women who had a history of using MHT but had quit more than 6 months prior to the reference date.
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Hormone Replacement Therapy And Breast Cancer Risk
Hormone replacement therapy also called estrogen replacement therapy, menopausal hormone therapy, or post-menopausal hormone therapy can be an effective treatment for menopausal symptoms, but its important to know that some types of HRT can increase your risk of breast cancer.
HRT also can increase your risk of the cancer coming back if youve been diagnosed with breast cancer in the past. Because of this risk, doctors usually recommend that women with a history of breast cancer should not take types of HRT that affect the entire body .
HRT has also been linked to cardiovascular risks, such as heart disease, stroke, and blood clots.
However, all of these risks vary and depend on many factors, including:
how long you use it
Years ago, before the link between HRT use and breast cancer risk was known, many women took HRT for years to ease menopausal symptoms and prevent bone loss. After 2002, when research linked HRT and breast cancer risk, the number of women taking HRT dropped dramatically.
Newer research that has followed women for a longer amount of time suggests the link between HRT and breast cancer risk is more complex than first thought, and using HRT remains a controversial topic.
Does Soy Cause Breast Cancer
But theres not enough data to suggest that the plant estrogens in soy foods, like tofu and miso, increase the risk for breast or other cancers. In fact, soy may have a protective effect. Soy is a plant estrogen. We really dont know the benefits and harms as they relate to cancer risk,Bevers says.
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Hormone Replacement Therapy May Be Safe After Breast Cancer Treatment
Hormone replacement therapy was thought to increase risk of cancer recurrence after breast cancer treatment, but that may not be the case
Hormone replacement therapy comes in different forms, including pills and patches
In women with a history of breast cancer, using hormone replacement therapy didnt increase the risk of breast cancer recurrence or death.
The findings of this latest, small study add to a growing body of research examining the effects of HRT on cancer risk.
Most breast cancers rely on the hormone oestrogen to grow, says Debasish Tripathy at the University of Texas MD Anderson Cancer Center in Houston. As such, many breast cancer therapies work by reducing or halting oestrogen production, which can lead to menopause-like symptoms.
The concern, then, is that increasing oestrogen levels to alleviate menopause symptoms could increase breast cancer risk, especially in people with a personal or family history of the condition.
Several studies have found that HRT is associated with an increased risk of breast cancer. Last year, however, an analysis of 300,000 women allayed some concerns about safety: it found that taking HRT to alleviate menopause symptoms doesnt increase the risk of dying early. Past research has also found that, in people who have had breast cancer, HRT can increase the risk of recurrence.
More on these topics:
Are Other Forms Of Hormone Therapy Safe
Although many other versions of hormone therapy exist, none have been put to the test of a long-term randomized trial such as the Womens Health Initiative. While it is possible that some form of hormones or hormone combinations may not increase the risk of breast cancer, the existing evidence suggests otherwise. Until proven otherwise through long-term randomized trials, we believe that women should assume that long-term use of hormone therapy increases breast cancer risk.
During the last several years, newer forms of therapy, called selective estrogen receptor modifiers , have become available. These drugs mimic some of the estrogen’s effects and have been used to treat hormone-sensitive breast cancers. Pharmaceutical companies hope to create a SERM that will help relieve hot flashes and vaginal dryness and prevent osteoporosis, heart disease and Alzheimer’s without increasing the risk of cancer or blood clots.
Thus far, companies have successfully created a SERM that reduces the risk of bone fracture without increasing the short-term risk of breast cancer.
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Implications For Clinicians And Policymakers
This study delivers more generalisable estimates of the different risks of breast cancer associated with specific progestogen components of HRT, while confirming no increased risks from short term use of oestrogen only, estradiol-dydrogesterone, and tibolone. Increasing duration of use was generally associated with increased risk, with tibolone and estradiol-dydrogesterone showing the smallest risks. The frequency of prescribing for treatments including dydrogesterone was, however, much lower than for those including norethisterone, medroxyprogesterone, or levonorgestrel.
What Hormones Are Used To Treat The Symptoms Of Menopause
The hormones most commonly used to treat symptoms of menopause are estrogen and progesterone. . Often, these 2 hormones are used together, but some women are given estrogen alone. Its important to know which hormones you are talking about when looking at the risks.
Common estrogen preparations used to treat menopausal symptoms include conjugated equine estrogens and estradiol, but several forms or types of estrogen are available.
There are also many progestins available, but medroxyprogesterone acetate , is often used with an estrogen to treat menopausal symptoms. Some preparations contain both an estrogen and a progestin.
Androgens are also sometimes used to treat menopausal symptoms. This is not common, though, and because only a few studies have looked at this practice, it isnt clear how safe it is in the long run.
Tibolone is a synthetic hormone drug that can act like estrogen, progesterone, and testosterone in different tissues of the body. Because this drug isnt available in the US, its not discussed here.
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What Is Already Known On This Topic
- Long term systemic use of hormone replacement therapy is associated with increased risks of breast cancer, mostly attributable to the progestogens medroxyprogesterone, norethisterone, and levonorgestrel
- After discontinuation of treatment, the increased risks decline, but remain raised for some years
- A recent large meta-analysis has reported higher than expected breast cancer risks associated with HRT
What Types Of Hormone Therapy Are Used For Breast Cancer
Several strategies are used to treat hormone-sensitive breast cancer:
Blocking ovarian function: Because the ovaries are the main source of estrogen in premenopausal women, estrogen levels in these women can be reduced by eliminating or suppressing ovarian function. Blocking ovarian function is called ovarian ablation.
Ovarian ablation can be done surgically in an operation to remove the ovaries or by treatment with radiation. This type of ovarian ablation is usually permanent.
Alternatively, ovarian function can be suppressed temporarily by treatment with drugs called gonadotropin-releasing hormone agonists, which are also known as luteinizing hormone-releasing hormone agonists. By mimicking GnRH, these medicines interfere with signals that stimulate the ovaries to produce estrogen.
Estrogen and progesterone production in premenopausal women. Drawing shows that in premenopausal women, estrogen and progesterone production by the ovaries is regulated by luteinizing hormone and luteinizing hormone-releasing hormone . The hypothalamus releases LHRH, which then causes the pituitary gland to make and secrete LH and follicle-stimulating hormone . LH and FSH cause the ovaries to make estrogen and progesterone, which act on the endometrium .
Blocking estrogens effects: Several types of drugs interfere with estrogens ability to stimulate the growth of breast cancer cells:
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Why Is This Important
The results support those found in earlier observational studies. They provide reassurance that HRT is linked to only a small increased risk of breast cancer.
The study contradicts a recent analysis, which pooled the results of 58 other studies and found higher than expected risk of breast cancer with HRT. That study could not make direct comparisons between types of HRT, or different durations of treatment.
The current research clarifies the types of HRT with the lowest risk and could guide the HRT of choice for many women. Oestrogen-only HRT has the lowest risk, but can only be taken by women who have had a hysterectomy. This work supports the current UK guidance around menopause, which says that there is little increased risk of breast cancer with oestrogen-only HRT.
Different types of combined HRT had different risks. The lowest was with dydrogesterone, which is not prescribed as often as other progestogens with higher risks .
An alternative to HRT, tibolone, was also associated with low risk. But the authors say it may not be as effective as HRT in managing menopausal symptoms and it is rarely prescribed.
How Do Hormones Affect Cancer
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Herbs And Supplements During Menopause
Many over-the-counter natural products are promoted in stores and online as helpful with menopausal symptoms. These include vitamins and soy-based and herbal products . There are also endless arrays of special blends of herbs and vitamins that claim to reduce the discomforts of menopause.
These products are considered dietary supplements . They have not been evaluated by the Food and Drug Administration to be sure that they work or even that they are safe. Some supplements have been tested in small clinical trials, but often the studies only looked at taking the substance for a short time , so it isnt clear how safe it would be if taken for a long time. Another concern has been applying the results of a study of a particular version and dose of a supplement to others that werent tested.
Most of the plain herbs that are touted for menopausal symptoms carry a low risk of harm for most women, but some can interact with other drugs and/or cause unexpected problems. You should discuss herbs or supplements with your doctor before taking them.
Well-controlled scientific studies are needed to help find out if these products work and if they are any safer than the hormone therapy drugs now in use.
Data On Cancer Risk From Hormone Therapy Reassuring Menopause Experts Say
Hormone therapy is used to treat night sweats, hot flashes and other symptoms associated with menopause.
A new scientific paper and other recent evidence offer important reassurances about the risk of breast cancer from hormone therapy to treat menopause symptoms, two School of Medicine menopause experts say.
Hormone therapy can help relieve menopause symptoms such as hot flashes, night sweats, sleep disturbances, vaginal issues, sexual problems and loss of bone density. But information has been conflicting on whether or how much this treatment increases recipients risk of breast cancer.
The new review in the scientific journal Menopause, combined with other recent findings, provides much-needed clarity, according to UVA Healths JoAnn V. Pinkerton, MD, and Carolyn S. Wilson, MD. Pinkerton and Wilson have outlined their thoughts on the review in an accompanying editorial co-written with Andrew M. Kaunitz, MD, of the University of Florida College of Medicine Jacksonville.
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What Are The Treatments For Noncyclic Breast Pain
Its more difficult to figure out the best treatment for noncyclic breast pain. Thats because its hard to know exactly where the pain is coming from. In addition, the pain is not hormonal. Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.