HRT and breast cancer: risk, prevention and alternatives
Hormone replacement therapy (HRT) is a treatment option for symptoms associated with menopause. Although it can increase the risk of breast cancer, this risk is low and will return to average after stopping HRT. A person should discuss the benefits and risks of HRT with a healthcare professional.
The risk of breast cancer can decrease dramatically after a person stops using HRT. However, the time it takes is not final.
The risk of breast cancer also depends on the type of HRT a person is taking.
There are two types of HRT: combined HRT, which contains both estrogen and progesterone, and estrogen-only HRT.
The following article explains how HRT increases breast cancer risk, ways to prevent breast cancer, and potential alternatives to HRT.
BreastCancer.org notes that the number of people using HRT has declined since research in 2002 initially found a link between HRT and breast cancer.
The researchers noted that prolonged or long-term use of combined therapies with progesterone and estrogen or estrogen alone significantly increased the risk of breast cancer.
They found that the level of risk may differ between types of HRT.
They also said that HRT using estradiol-dydrogesterone had the lowest risk of developing breast cancer and the risk seemed to decrease after stopping HRT use.
Breast cancer now, a UK charity, notes that the risk of developing breast cancer in someone aged 50 to 96 is as follows:
- 63 in 1,000 women who have never taken HRT
- 83 in 1,000 women who use combined HRT for 5 years
- 68 in 1,000 women who use estrogen-only HRT for 5 years
Estrogen and progesterone combined may have the highest risk factor for any type of HRT. According to BreastCancer.org, the risk of developing breast cancer increases by 75% in people taking combined HRT.
The organization also noted that combined HRT increases the chances that a healthcare professional can diagnose a person’s breast cancer at a later stage, which increases the likelihood of death.
American Cancer Society (ACS) Says Breast Cancer Risk Is Returning to Average 3 years after a person stops combined HRT.
However, researchers in the 2020 study found that the risk decreased after 5 years for medroxyprogesterone and 10 years for levonorgestrel, which are types of progesterone.
Combination HRT is also linked to breast density, which can make it more difficult to locate cancer on a mammogram. Breast density is a term that describes the amount of dense tissue relative to fatty tissue in a person’s breast. Dense tissue is more fibrous than fatty tissue.
HRT containing estrogen alone may also increase a person’s risk of developing breast cancer. However, this can only increase the risk after 10 years of continuous use.
A person who has had or has breast cancer should not take HRT. Instead, they should talk to a doctor about the alternative options.
According to ACS, using HRT after breast cancer may increase the risk of recurrence or development of new tumors.
The American College of Obstetricians and Gynecologists notes that first-line choices for managing menopause symptoms in people during or after their breast cancer treatment include non-hormonal approaches.
These include moisturizers, topical anesthetics, and lubricants to treat vaginal symptoms.
Those with a history of estrogen-dependent breast cancer may use vaginal estrogen therapy if they don’t respond to non-hormonal approaches. Vaginal estrogen therapy delivers low doses of hormones.
A 2019 article in the journal Breast Cancer Archives states that there are no guidelines on the safety of using HRT in people with a family history of breast cancer.
A Systematic review from 2021 notes that HRT has no relevant effect on the risk of cancer in people carrying the BRCA gene.
Breast cancer now suggests that a person should talk to a doctor before using HRT if they have inherited a breast cancer gene, such as BRCA1 or BRCA2.
If a person decides to take HRT, they may request a lower dose formula. They can also discuss with a doctor how to take it as quickly as possible.
BreastCancer.org Note that there are things there are things that people can do to reduce their risk of developing breast cancer, whether or not they are using HRT.
They recommend a person:
- regular exercise
- eating foods rich in nutrients
- stop smoking, if necessary
- limit their alcohol consumption
It is also important to achieve and maintain a healthy weight. This is because having more fatty tissue can increase a person’s estrogen levels and as a result, increase the chances to develop breast cancer.
The ACS adds that a person at higher risk of breast cancer may benefit from additional measures, such as:
- close surveillance
- ask for genetic testing and counseling
- get preventive surgery
For people at high risk of developing breast cancer, an oncologist can prescribe drugs such as tamoxifen and raloxifene.
The benefits of taking HRT may vary from person to person. Some people decide that the benefits outweigh the risks.
HRT can help relieve symptoms of menopause. It can also help reduce the risk of developing osteoporosis.
A person should discuss the benefits and risks with a healthcare professional before deciding whether HRT is right for them.
If a person decides to take HRT, they should attend all of their breast cancer screening appointments.
Some companies produce bioidentical hormone therapy. Bioidentical hormones are theoretically derived from plants.
Many companies claim that their bioidentical hormonal products are a safer alternative to conventional HRT, which may consist of synthetic hormones. However, the Food and Drug Administration (FDA) does not regulate these supplements.
In addition, the higher risk of breast cancer is same for bio-identical hormones as for synthetic hormones. Synthetic hormones are made in the laboratory and chemically identical to those in the body.
A person should speak with a doctor about the risks of HRT, especially if they already have a higher risk of developing breast cancer. Their doctor will likely suggest a different treatment plan that doesn’t involve HRT.
According to Women’s health office, a person may not need formal treatment for their menopause symptoms. When they do, some treatments that don’t involve HRT may include:
- over-the-counter or prescription products to treat vaginal dryness or discomfort, such as vaginal lubricants
- natural remedies, such as soybeans or red clover
- mind and body practices, such as yoga or acupuncture
Exercise can help improve mood and sleep, and reduce hot flashes. A person should also avoid spicy foods, caffeine, and alcohol as they can cause hot flashes.
A person can learn more about natural remedies to help manage the symptoms here.
A person can also take the following medications:
- Clonidine: It is a drug that treats high blood pressure. It may be able to reduce hot flashes and night sweats. However, it can cause side effects including low blood pressure, dry mouth, depression, constipation, and drowsiness. A person can take this medicine for 2-4 weeks to see if it’s effective. If not, a person should stop taking it.
- Antidepressants: Examples include venlafaxine and citalopram. These may be able to treat hot flashes. Side effects can include nausea, dizziness, trouble sleeping, and anxiety. They can also cause low libido and weight gain.
- Tibolone: Tibolone is similar to combined HRT. It is a synthetic hormone that those who have a uterus can take. However, it contains both estrogen and progesterone, so if a person is unable to take HRT due to medical conditions, they will not be allowed to take this drug.
HRT increases the risk of breast cancer. The risk tends to increase with combination therapies as well as with long term use.
A person who has had breast cancer or has a family history of the disease should see a doctor before using HRT for their menopausal symptoms. A doctor can discuss other solutions which may include over-the-counter and prescription medications, as well as natural and holistic therapies.