HRT was again in the spotlight last night after a study from Oxford discovered that it increased the risk of breast cancer by a third.
Researchers said women aged 50 to 69 were 32 percent more likely to get the disease if they had used the most common form of hormone replacement therapy for at least five years.
The risk was twice as great for patients who had been in treatment for ten years.
However, the Oxford team said the overall risk was still small – and doctors said the benefits often outweigh the risks.
Based on 58 global studies, the study suggested that HRT causes about one in 20 cases of breast cancer – nearly 3,000 a year in the UK.
However, the Oxford team said the overall risk was still small – and doctors said the benefits often outweigh the risks.
The extra risk lasted ten or more years after women stopped treatment. Only those who appeared for less than a year had no greater or lesser chance of developing cancer.
The study showed that 8.3 percent of patients who used HRT for five years developed breast cancer, compared to 6.3 percent of women who were not treated.
BBC Kirsty: I still take it AFTER my cancer fight
Kirsty Lang used HRT for four years when she was diagnosed with breast cancer in 2016.
The 57-year-old broadcaster & # 39; threw her HST plasters in the trash & # 39; but discovered that paralyzing menopause symptoms, including loss of libido and night sweats, returned.
After successful chemotherapy and surgery to remove the tumor, Miss Lang has now returned to a combined treatment with progesterone and estrogen. The BBC Radio 4 presenter says that HRT has dramatically improved her quality of life and urged other women yesterday to keep the risks of the treatment in context.
"I made a careful decision after weighing the evidence and calculating the risk," she said. "HRT has been demonized for years, but the risk is still small. There are various lifestyle factors that increase your risk of breast cancer, including alcohol, sugar and being overweight.
"Women must put all of this in context.
"This study does not mean that you should stop taking HRT if it is worth it for your quality of life.
"The suicide rate for women aged 51 to 54 is higher than in any other age group. HRT can really be life saving. & # 39;
Miss Lang also takes tamoxifen, a hormone therapy that is used to treat breast cancer. Doctors say it's OK for women who have had cancer at an early stage to use HRT when they use tamoxifen.
The authors said they were worried that GPs told women not to worry about the risks.
Without & # 39; alarming & # 39; to be, they suggested that the NHS should update its guidelines.
Doctors, however, urged women not to panic and said the benefits of relieving night sweats, depression, and hot flashes often outweighed the risks.
Others pointed out that most HRT patients would sleep better and exercise more, which would improve their health and lower their risk of background cancer.
The study was published in Lancet and was conducted by the same researchers at Oxford University who were involved in one of the two original – and much smaller – studies in 2002 and 2003 that first raised the link to breast cancer.
It confirmed these original findings and showed that the risk was much longer than expected.
Author professor Valerie Beral said: "This study has collected all global data.
& # 39; It shows a persistent risk of breast cancer for ten to fifteen years, even after people stop using menopausal hormone therapy, none of which was known before.
& # 39; Previous estimates of risk & # 39; s are approximately doubled by the inclusion of the persistent risk after the hormone use has ceased.
& # 39; We are concerned that general practitioners are telling women they don't need to worry. & # 39;
Co-author Professor Richard Peto said: "We don't want to be unnecessarily alarming, but we don't want to be too reassuring.
& # 39; Guidelines must be reviewed in the light of accurate information. Currently, the risk of HRT is incorrectly displayed.
Broadcaster Kirsty Lang, 57, & # 39; threw her HST plasters in the trash & # 39; but discovered that paralyzing menopause symptoms, including loss of libido and night sweats, returned
& # 39; The NHS Choices website talks about a breast cancer risk of two per thousand women, but actually that is 20 per thousand. & # 39;
Baroness Delyth Morgan, of Breast Cancer Care and Breast Cancer Now, said the study provided important new information.
IS THERE A DISCOUNT OF HRT PILLS?
Women have been forced to buy HST drugs from abroad because it is now almost impossible to get to Britain, it was reported on Saturday.
The deficits have been going on for months but last week reached the & # 39; crisis point & # 39; because most Evorel patches – the British market leader – disappeared from the shelves.
Many alternatives were already out of stock. The two most important pharmaceutical wholesalers were also completely empty of all generally prescribed HST patches, according to an Daily Mail audit.
With the support of the Ministry of Health, manufacturers have rationed the small proportion that they have rationed because of the & # 39; disastrous & # 39; approach to the crisis.
Some women have bought boxes for their friends from pharmacies during their vacation in Spain. One patient even has air cargo HST from South Africa.
Approximately two-thirds of HRT treatments have been affected by shortages. They include Evorel and Elleste, the two most popular brands, which are prescribed to more than 100,000 women a year – more than half of those undergoing treatment.
She added: "Taking HRT is a truly personal decision and it is vital that everyone fully understands the benefits and risks, discusses it with their doctor and is supported to make the right decision.
"These robust findings also tell us more about the long-term impact of different types of HRT on breast cancer risk, and instead of worrying, we hope that they will help anyone considering HRT make an even better informed decision .
"On balance, many women will consider HRT as a necessity, because it can be really effective in controlling debilitating menopausal symptoms such as hot flashes.
& # 39; To minimize the risk of breast cancer, it is normally recommended that the lowest possible effective dose is used as short as possible. & # 39;
Dr. Louise Newson, a doctor specializing in menopause, said: "The very small increased risk of breast cancer must be placed in a context that is balanced against the health benefits of HRT. Menopause symptoms can be debilitating and HRT transforms the lives of thousands of women.
"I see many patients who have had breast cancer and chemotherapy, but still choose to use HRT because of the benefits, including protection against osteoporosis.
"Most women with HRT start to sleep better and exercise more, so they improve their overall health and lower their background risk of cancer."
Professor Janice Rymer of the Royal College of Obstetricians and Gynecologists said patients should be warned about the small increase in breast cancer risk so that they can weigh it against the costs and benefits.
"Unfortunately, many women still suffer in silence and are reluctant to seek advice and support because of concerns about the risks of breast cancer associated with HRT," she said.
"These findings should not prevent women from using HRT if the benefits – such as bone protection and cardiovascular risk reduction – outweigh the risks.
IS THERE A RISK THAT USES HRT FOR WOMEN THROUGH THE MENOPAUSE?
Menopause, which often affects women in their late 40s and early 50s, can cause depression, hot flashes, headaches and night sweats. In the long term, it can also cause bone disease and memory loss.
Hormone replacement therapy (HRT) addresses these symptoms by replacing female sex hormones – estrogen and progestin – when the body stops producing them.
But although it can transform the lives of many women, studies have shown that there can be an increased risk of breast cancer and heart disease due to HRT. As a result, many women no longer accept HRT treatment and some doctors will not prescribe it.
However, it was noted in the Woman & # 39; s Health Concern (WHC) that one of the American studies in the mid-1960s used women who were often overweight as test subjects, and these are not representative of women in the UK.
In addition, a controlled study from Denmark, reported in 2012, showed that healthy women who use HRT for 10 years immediately after the menopause had a reduced risk of heart disease and die of heart disease, which contradicts the reports of previous studies .
The WHC states that HRT is safe, provided it is taken for the right reasons, i.e. to relieve menopause symptoms, and at the minimum effective dose.
"To put the risk in context, a woman has a greater risk of developing breast cancer if she is overweight or obese compared to HRT."
Professor Martin Marshall of the Royal College of GPs said: & # 39; We would like to urge patients not to panic as a result of this study and to continue taking HRT as they have been prescribed – and we would encourage prescribers to do this normally until clinical guidelines recommend otherwise. & # 39;
The extent to which women depend on HRT has been demonstrated by shortages – revealed by the Mail – which have made it difficult for patients to get supplies, with some even abroad.
One hundred thousand British women take the treatment in gels, plasters or pills.
Sarah Branch, from the Medicines and Healthcare products Regulatory Agency, said that women who have used HRT should be alert to signs of breast cancer.
She added: "No medication is completely risk-free, but it is important that women can make an informed decision about the risks and benefits."
Yes, there are cancer risks – but I would still prescribe HRT, writes breast surgeon PROF KEFAH MUG
For years I have told my patients: "If I were a woman with troublesome menopausal symptoms, I would use HRT for at least five years." Does this latest study change my opinion? Absolutely not.
Day after day, patients tell me how their lives are terribly affected by their menopausal symptoms: they cannot sleep, they cannot think clearly, they have no energy, their skin and hair are brittle and dry, they find it difficult to cope with it go to work and home due to constant hot flashes. Their sex life can also suffer.
Professor Kefah Mokbel is an oncoplastic breast surgeon and said the latest study has not changed his view of HRT
These kinds of symptoms can put them under enormous stress. I have even seen women who are so under pressure because of the menopause that they run the risk of developing a disease – but a study cannot take that into account. So I think it would be a tragedy for women to decide not to try HRT because of these findings.
That does not mean that the research does not raise interesting issues; it does that, and by involving 100,000 women, it brings together an impressive amount of data.
In short, what it shows is that at most two out of every 100 women who use HRT will develop breast cancer as a result. The other 98 will have had the benefit of an increased quality of life, freed from the suffering of their menopausal symptoms, and will therefore not get cancer.
It is a consideration – and for many women, their symptoms are so painful that they are willing to take the associated risks.
What the study does not demonstrate is the death rate from breast cancer that causes HRT – that is, how many die as a result.
Because if you develop but can cure breast cancer, that's an important distinction.
In addition, there are ways to limit the risks – not least by taking the right type of HRT. I find it worrying that many doctors continue to prescribe obsolete forms, which puts women at greater risk if there are safer options.
HRT usually includes a combination of a form of estrogen that acts on the central nervous system and improves symptoms such as hot flashes, the texture of skin and hair and increases the efficiency of mitochondria in cells to improve energy.
It also improves memory and joint health. However, taking estrogen alone can increase the risk of uterine cancer, therefore it is given in combination with progestin, a synthetic form of progesterone. This hormone also helps with sleep quality and may have other benefits such as helping to lower blood pressure.
The problem is that when you take estrogen orally, it travels through the system and breaks down in the liver in countless by-products called metabolites – and it is these that cause problems such as blood clots, stroke, and possibly breast cancer. But if you have estrogen in plaster form or gel, it goes straight into the bloodstream.
Given this fact, I cannot understand why doctors continue to give HRT as a pill. I prefer to take a form of estrogen called estradiol as a patch – although some of these patches are unfortunately out of stock or almost empty due to shortages. It is accompanied by natural progesterone, taken orally at intervals, with a break every month as advised by your doctor. You also cannot take it as a patch because there is no evidence that it is absorbed in sufficient quantities to reduce the risk of uterine cancer when given this way.
This is a more natural way to have HRT, and some studies find that using it in this way does not increase the risk of breast cancer at all.
The other way to change the risks of HRT is to take it for the shortest possible time. This study has shown that the shorter the duration, the lower the risk of breast cancer.
It states that the risk of cancer is increased for another ten years after you stop taking HRT, but in fact it was already established. And let's not forget how great that risk is – the answer is, as said before, still small.
If women do not experience disturbing symptoms and find that they can cope with their menopause without medical assistance, then everything is well and good. But those who think they need help should not be afraid of seeking help.
Right now I have twins as a patient – one of them took HRT and one didn't. Both have had breast cancer and the only difference between their individual situations is that the person who used HRT looks years younger and has had a much better quality of life so far.
The sad truth is that some people will develop cancer regardless of their lifestyle; nothing in life is without risk. It is the size of the risk compared to the benefit that you always have to weigh. That's what women have to remember.
Professor Kefah Mokbel is chairman of the multidisciplinary breast cancer program of the London Breast Institute and consultant oncoplastic breast surgeon at the Princess Grace Hospital in the capital.
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