HRT
Increases Risk of Cancer Recurrence in Women Treated for Breast
Cancer
According to a recent article published in The Lancet, hormone
replacement therapy following treatment for early breast cancer
increases the risk of developing a cancer recurrence. This
clinical trial was closed prematurely due to these results.
1
Hormone replacement therapy (HRT) is often prescribed for
women during menopause. Menopause is a natural phase of maturing
womanhood, during which the ovaries produce significantly
less estrogen, ovulation ceases and menstruation ends. For
many women, menopause has uncomfortable side effects. Hot
flashes, sleep disturbances, depression, mood swings and anxiety
may affect the menopausal woman. Additionally, menopause may
also be accompanied by increased urinary tract infections,
incontinence, vaginal discomfort due to a lack of estrogen-based
lubrication and decreased bone density. HRT has been effectively
used to mitigate these side effects and is widely prescribed
for women experiencing these unpleasant symptoms of menopause.
Recent results from several clinical studies have demonstrated
a correlation between the use of hormone therapy and an increase
in the risk of developing breast cancer, and recently results
from a clinical trial demonstrated an increase in death from
breast cancer associated with the use of HRT. 2 HRT can contain
estrogen alone, progesterone alone or a combination of the
two hormones. Research continues in order to answers questions
regarding different outcomes for patients who use specific
combinations or single-agent HRT as well as duration of use.
Researchers from Sweden conducted a clinical trial that was
initiated in 1997 to evaluate HRT in patients who had been
treated for localized breast cancer (cancer that had not spread
to distant sites in the body). This study included 434 patients,
219 of whom were prescribed HRT, and 215 of whom did not received
HRT. One half of the patients had hormone receptor-positive
breast cancer, (cancer that is stimulated to grow from exposure
to estrogen), one quarter had hormone receptor-negative breast
cancer (cancer that is not stimulated to grow from exposure
to estrogen), and one quarter of patients did not have their
receptor status known. After an average of approximately 2
years follow-up, patients treated with HRT had nearly 4 times
the rate of a cancer recurrence (26 patients) compared to
those not treated with HRT (7 patients). Patients who had
initially been diagnosed with hormone receptor-positive cancer
had a significantly higher rate of developing a cancer recurrence
than patients diagnosed with hormone receptor-negative breast
cancer. Furthermore, patients who had been treated with HRT
prior to their diagnosis of breast cancer also had a significantly
higher rate of the development of a cancer recurrence than
those who had not received HRT prior to their diagnosis.
The researchers concluded that HRT given following the treatment
for early breast cancer, or prior to the diagnosis of breast
cancer, increases the risk of developing a recurrence. These
results remain consistent with results from previous clinical
trials that suggest an association between HRT and breast
cancer. However, it is important for patients to speak with
their healthcare provider about their individual benefits
and risk with HRT.
References:
1. Holmberg L, Anderson H, for the HABITS Steering and Data
Monitoring Committees, HABITS (Hormonal Replacement Therapy
After Breast Cancer-is it Safe?), A Randomized Comparison:Trial
Stopped. The Lancet, Published Online February 3, 2004. http://image.the
Lancet.com/extrax/03et12260web.pdf.
2. Million Women Collaborators. Breast Cancer and Hormonal-Replacement
Therapy in the Million Women Study. The Lancet. 2003;362:419-427.
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