Menopausal hormone therapy: why we should no longer be afraid of the breast cancer risk

Abstract

The threat that women may develop breast cancer is the major reason why both physicians and women are afraid to use menopausal hormone therapy (MHT). The fear pertains to estrogen–progestin replacement therapy (EPRT) as estrogen-alone replacement therapy has no, or even a reduced, breast cancer risk. We reviewed the way breast cancer risk with EPRT was reported in some major publications since 2002 and tried to put the use–risk association in context. We hope this will make it easier for the physician and the menopausal woman to understand the risk involved and allow more confident and more informed decision-making regarding MHT use. We conclude that there are five interrelated reasons why physicians and women should no longer be afraid of the breast cancer risk with EPRT. We submit that breast cancer related to EPRT use is rare because the risk is very low; the reported increase in breast cancer risk with EPRT is not relevant to current practice; modifiable lifestyle factors, not EPRT, are the real risks for breast cancer; breast cancer-specific mortality is reduced in women who develop breast cancer while on EPRT; and avoiding MHT use when indicated puts a woman in harm’s way.

摘要

乳腺癌风险是医生和女性都害怕应用绝经激素治疗 (MHT) 的主要原因。这种担忧与雌激素-孕激素替代疗法 (EPRT) 有关, 因为单独应用雌激素替代疗法不增加甚至降低了乳腺癌风险。我们回顾了自 2002 年以来在一些主要出版物中有关EPRT 与乳腺癌风险的报告, 本文描述MHT相关乳腺癌风险。我们希望这将使医生和绝经女性更容易了解相关风险, 并更自信和更明智地进行MHT。我们总结了医生和女性不应再害怕 EPRT 乳腺癌风险的五个相关原因。我们认为与应用 EPRT 相关的乳腺癌很少见, 因为风险非常低；报告的 EPRT 增加乳腺癌风险与当前实践无关；可改变的不良生活方式才是乳腺癌的真正风险, 而非EPRT；在 EPRT 期间发生乳腺癌的女性乳腺癌相关死亡率低；在有EPRT指征却不应用激素治疗不利于女性健康。

Keywords:

• Menopausal hormone therapy
• breast cancer
• categories of risk
• attributable risk
• baseline risk

Potential conflict of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Source of funding

Nil.