MidLife
The cancer risk associated with hormone replacement therapy
Replacement hormones (estrogen or a combination of estrogen and progestin) have been shown to be effective in relieving conditions usually related to menopause. These conditions include hot flashes, vaginal tissue dryness, and an increased risk for osteoporosis (thinning of the bones). However, the use of estrogen alone during or after menopause has been linked to an increase in endometrial cancer (cancer of the lining of the uterus). There is also some suggestion that it is linked to breast cancer as well.
Many health care providers feel that for most women, the benefits of HRT (for example, a reduction in the risk of osteoporosis and possibly of cardiovascular disease) may outweigh the possible cancer risks. The National Institute of Health’s (NIH) Women’s Health Initiative, the largest clinical trial in the U.S., is exploring the association between HRT and the development of breast and colon cancer, heart disease and osteoporosis. Check with your health care provider and discuss the issues related to your own family history and personal risk factors carefully to make the best possible decision about HRT for you.
Studies have shown that women taking replacement estrogen have a two to eight fold risk of developing endometrial cancer than women who do not take estrogen. The risk increases after 2 to 4 years of estrogen use and seems to be greatest when large doses are taken or when the preparations are used for long periods of time. Using a combination of estrogen and progestin appears to reduce the risk linked to use of estrogen alone. However, decisions should be made on a case-by-case basis.
The National Cancer Institute (NCI) advises a woman to thoroughly discuss the question of hormone replacement therapy with her health care provider. If the decision is made to use hormone treatment,the dosages as well as the duration of use should be carefully considered in relation to the benefits and risks.
Before hormone replacement therapy is begun, a pretreatment mammogram (x-ray of the breast) usually is taken. After menopause, the breast tissue becomes flatter and smoother. Breast tissue responds to hormone replacement by becoming denser and more like the premenopausal breast. It is especially important, for a woman on hormone replacement therapy, that she be checked yearly for any signs of cancer. Vaginal bleeding should be reported to the doctor at once. Also, a woman on hormone replacement therapy should examine her breasts monthly for lumps or changes in appearance that may be warning signs of cancer.
