Breast Cancer and HRT

Breast Cancer and Hormone Replacement Therapy

Oncologist James Cantrell, MD, highlights the rumors, facts and studies surrounding the link between HRT and breast cancer.


“In general hormone replacement therapy (HRT) in post-menopausal women does increase the risk of breast cancer, but it’s variable,” says James E. Cantrell, MD, an oncologist with Birmingham Hematology Oncology Associates of Birmingham.


The big study. The one really large scientific study that currently defines the correlation between HRT and breast cancer was done by the Women’s Health Initiative (WHI), says Dr. Cantrell. But it was only short-term, just shy of six years.


Progestin not good. In the study, one group of post-menopausal women was given a combination pill containing both estrogen and progestin. “The combination definitely showed an increase in your risk of breast cancer,” says Dr. Cantrell. “Consequently, most physicians would recommend not exposing yourself to the combination therapy.”


But estrogen alone? In the same study, another group of women were given just estrogen alone. Estrogen alone appeared to lower the risk of breast cancer, but just barely. “But estrogen is where women get the most benefits of hormone replacement,” explains Dr. Cantrell.


A big “but”. Though that study showed that estrogen lowered the risk of breast cancer slightly, “HRT is still not routinely recommended, because in thousands of scientifically-valid observational trials, there is a correlation between taking estrogen and breast cancer risk,” says Dr. Cantrell.


So now what? “The issue would be whether your symptoms are severe enough to warrant taking HRT. It’s very subjective, but things like recurring bladder infections could be a reason,” says Dr. Cantrell.


If you’re on estrogen now. “Talk to your physician about your menopausal symptoms,” advises Dr. Cantrell. “Because there are other risks associated with estrogen, like venous thrombosis. If you’ve had breast cancer in last 10 years, any HRT is contraindicated.”


And finally. “If you have significant symptoms of menopause, like severe hot flashes, vaginal dryness or depression, then a physician can, with good scientific basis, choose to help you bridge that pre- and post-menopausal gap with some hormone replacement therapy. But for only a few years,” says Dr. Cantrell. “After that, taking estrogen would be a case-by-case decision based on the risks versus the symptoms.”


by Jane Ehrhardt

To read more about Dr. James E. Cantrell, click here.

To read more on Birmingham Hematology Oncology Associates in Birmingham, click here.

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