HRT was back in the spotlight last night after an Oxford study found it raised the risk of breast cancer by a third.
Researchers said women aged 50 to 69 were 32 per cent more likely to get the disease if they had taken the most common form of the hormone replacement therapy for at least five years.
The danger was twice as high for patients on the treatment for a decade.
The Oxford team said however that the overall risk was still small – and doctors said the benefits often outweighed the risks.
Based on 58 global studies, the research suggested that HRT causes around one in 20 cases of breast cancer – nearly 3,000 a year in Britain.
The Oxford team said however that the overall risk was still small – and doctors said the benefits often outweighed the risks
The extra risk lasted for ten or more years after women stopped the treatment. Only those on it for less than a year were found to have no greater or little chance of cancer.
The study showed that 8.3 per cent of patients taking HRT for five years developed breast cancer, compared with 6.3 per cent of women not on the treatment.
BBC Kirsty: I still take it AFTER my cancer fight
Kirsty Lang had been taking HRT for four years when she was diagnosed with breast cancer in 2016.
The 57-year-old broadcaster ‘threw her HRT patches in the bin’ but found that crippling menopause symptoms, including loss of libido and night sweats, returned.
After successful chemotherapy and surgery to remove the tumour, Miss Lang has now returned to combined progesterone and oestrogen treatment. The BBC Radio 4 presenter says HRT massively improves her quality of life and yesterday urged other women to keep the risks of the treatment in context.
‘I made a careful decision after weighing up the evidence and calculating the risk,’ she said. ‘HRT has been demonised for years but the risk is still small. There are various lifestyle factors that increase your risk of getting breast cancer, including alcohol, sugar and being overweight.
‘Women must put all of these into context.
‘This study does not mean you should stop taking HRT if it is worth it for your quality of life.
‘The suicide rate for 51- to 54-year-old menopausal women is higher than in any other age group. HRT really can be life-saving.’
Miss Lang also takes tamoxifen, a hormone therapy used to treat breast cancer. Doctors say it is OK for women who have had early-stage cancer to take HRT if they are on tamoxifen.
Its authors said they were concerned that GPs were telling women not to worry about the risks.
Without wanting to be ‘unduly alarming’, they suggested the NHS should update its guidelines.
Doctors urged women not to panic however, saying the benefits of relieving night sweats, depression and hot flushes often outweighed the risks.
Others pointed out that most HRT patients would start sleeping better and exercising more, improving their health and lowering their background cancer risk.
Published in the Lancet, the research was by the same Oxford University researchers involved in one of the two original – and much smaller – studies in 2002 and 2003 that first raised the breast cancer link.
It confirmed these original findings and showed the risk persisted much longer than thought.
Author Professor Valerie Beral said: ‘This study has brought together all worldwide evidence.
‘It shows a persistent risk of breast cancer for ten to 15 years even after people stop taking menopausal hormone therapy, this was not known about before.
‘Previous estimates of risks are approximately doubled by the inclusion of the persistent risk after use of the hormones ceases.
‘We are concerned GPs are telling women they don’t need to worry about it.’
Co-author Professor Richard Peto said: ‘We don’t want to be unduly alarming but we don’t want to be unduly reassuring.
Broadcaster Kirsty Lang, 57, ‘threw her HRT patches in the bin’ but found that crippling menopause symptoms, including loss of libido and night sweats, returned
‘Guidelines should be reconsidered in light of accurate information. Currently the risk of HRT is misrepresented.
‘The NHS Choices website talks of a breast cancer risk of two per thousand women but actually it is 20 per thousand.’
Baroness Delyth Morgan, of Breast Cancer Care and Breast Cancer Now, said the study provided important new information.
IS THERE A SHORTAGE OF HRT PILLS?
Women have been forced into buying HRT medication from abroad as it is now almost impossible to get in Britain, it was reported on Saturday.
Shortages have been going on for months but reached ‘crisis point’ last week as most Evorel patches – the UK market leader – disappeared from the shelves.
Many alternatives were already out of stock. The two main pharmaceutical wholesalers also completely ran out of all commonly-prescribed HRT patches, according to an audit seen by the Daily Mail.
Manufacturers have rationed what little stock they have with the support of the Department of Health, which has been slammed for its ‘disastrous’ handling of the crisis.
Some women have bought boxes for their friends from pharmacies while on holiday in Spain. One patient has even air-freighted HRT from South Africa.
Around two-thirds of HRT treatments have been hit by shortages. They include Evorel and Elleste, the two most popular brands, which are prescribed to upwards of 100,000 women a year – more than half of those on the treatment.
She added: ‘Taking HRT is a really personal decision, and it’s vital that everyone fully understands the benefits and risks, discusses them with their GP and is supported to make the decision that’s right for them.
‘These robust findings also tell us more about the long-term impact of different types of HRT on breast cancer risk, and, rather than causing concern, we hope they will help anyone considering HRT treatment to make an even more informed decision.
‘On balance, many women will feel HRT to be a necessity, as it can be really effective in helping them control debilitating menopausal symptoms such as hot flushes.
‘In order to minimise the risk of breast cancer, it is normally recommended that the lowest effective dose is used for the shortest possible time.’
Dr Louise Newson, a GP who specialises in the menopause, said: ‘The very small increased breast cancer risk needs to be put in context balanced against the health benefits of HRT. Menopause symptoms can be debilitating and HRT transforms the lives of thousands of women.
‘I see a lot of patients who have had breast cancer and chemotherapy but still choose to take HRT because of the benefits, which include protecting against osteoporosis.
‘Most women on HRT will start sleeping better and exercising more, therefore they improve their overall health and lower their background risk of cancer.’
Professor Janice Rymer, of the Royal College of Obstetricians and Gynaecologists, said patients should be warned of the small increase in risk of breast cancer so they can weigh these up against the costs and benefits.
‘Unfortunately, many women are still suffering in silence and are reluctant to seek advice and support due to concerns around the risks of breast cancer associated with HRT,’ she said.
‘These findings should not put women off taking HRT if the benefits – such as protection of bones and decrease in cardiovascular risk – outweigh the risks.
IS THERE ANY RISK USING HRT FOR WOMEN GOING THROUGH MENOPAUSE?
Menopause, which commonly strikes women in their late 40s and early 50s, can cause depression, hot flushes, headaches and night sweats. Long term, it can also cause bone disease and memory loss.
Hormone replacement therapy (HRT) tackles these symptoms by replacing the female sex hormones – oestrogen and progestogen – as the body stops producing them.
But while it can transform the lives of many women, studies have shown that there may be an increased risk of breast cancer and heart disease from HRT. As a result, many women no longer accept HRT treatment and some doctors will not prescribe it.
It was however noted by the Woman’s Health Concern (WHC) that one of the American studies used women in their mid-sixties who were often overweight as subjects, and these are unrepresentative of women in the UK.
Furthermore, a controlled trial from Denmark reported in 2012 has demonstrated that healthy women taking combined HRT for 10 years immediately after the menopause had a reduced risk of heart disease and of dying from heart disease, contradicting the reports of the earlier studies.
The WHC says HRT is safe provided it is taken for the correct reasons, i.e. to alleviate the symptoms of the menopause, and at the minimum effective dose.
‘To put the risk into context, a woman has greater risk of developing breast cancer if she is overweight or obese compared to taking HRT.’
Professor Martin Marshall of the Royal College of GPs said: ‘We would urge patients not to panic as a result of this research, and to continue taking HRT as it has been prescribed to them – and we would urge prescribers to do so as normal, until clinical guidelines recommend otherwise.’
The extent to which women rely on HRT has been shown by shortages – revealed by the Mail – that have left patients scrambling to get supplies, with some even buying from abroad.
Several hundred thousand British women take the treatment in gels, patches or pills.
Sarah Branch, of the Medicines and Healthcare products Regulatory Agency, said women who have used HRT should be vigilant about signs of breast cancer.
She added: ‘No medicine is completely without risk, but it is important for women to be able to make an informed decision about the risks and benefits.’
Yes, there are cancer risks – but I’d still prescribe HRT, writes breast surgeon PROF KEFAH MOKBEL
For years I have been telling my patients: ‘If I was a woman with troubling menopausal symptoms, I would take HRT for at least five years.’ Does this latest study change my view? Absolutely not.
Day after day, patients tell me how their lives are being dreadfully affected by their menopausal symptoms: they cannot sleep, they cannot think straight, they have no energy, their skin and hair is brittle and dry, they are finding it hard to cope at work and home due to constant hot flushes. Their sex life might be suffering too.
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. In fact I have seen women who are under such stress because of the menopause that they run the risk of developing an illness as a result – but a study can’t factor in things like that. So I think it would be a tragedy if women decided not to try HRT because of these findings.
That is not to say that the research doesn’t raise interesting issues; it does, and by involving 100,000 women it is bringing together an impressive amount of data.
Put bluntly, what it shows is that at most two in every hundred women who take 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 distress of their menopausal symptoms, and will not get cancer as a result.
It is a trade-off – and for many women their symptoms are so distressing that they are prepared to take the associated risks
What the study does not show is the mortality rate of the breast cancer that HRT causes – that is to say how many die as a result.
Because if you do develop breast cancer, but can be cured, then that is an important distinction.
Besides, there are ways you can mitigate the risks – not least by taking the right type of HRT. I find it distressing that many doctors continue to prescribe outdated forms that leave women in increased danger when there are safer options.
HRT usually involves a combination of a form of oestrogen, which works on the central nervous system and improves symptoms such as hot flushes, the texture of skin and hair and increases the efficiency of mitochondria in cells to help improve energy.
It also improves memory and joint health. However, taking oestrogen alone can increase the risk of womb cancer, which is why it is given in combination with progestogen, a synthetic form of progesterone. This hormone also helps with sleep quality, and can have other benefits such as helping to reduce blood pressure.
The trouble is that when you take oestrogen orally it travels through the system and is broken down in the liver into numerous byproducts called metabolites – and it is these that cause problems such as blood clots, stroke and potentially breast cancer. But if you have oestrogen in patch form or gel then it goes straight into the blood stream.
Given this fact, I cannot understand why doctors continue to give out HRT as a pill. I favour taking a form of oestrogen called estradiol as a patch – although unfortunately some of these patches are out of stock or running low due to shortages. It is accompanied by natural progesterone taken orally on an intermittent basis, with a break each month as advised by your doctor. You cannot take it as a patch as well because there is no evidence that it is absorbed in sufficient quantities to reduce the risk of womb cancer when given this way.
This is a more natural way of having HRT, and some studies find that taking it this way does not increase the risk of breast cancer at all.
The other way to modify the risks of HRT is to take it for the shortest time possible. This study has found that the shorter the duration the lower the risk of breast cancer.
It mentions that the risk of cancer remains elevated for ten years after you have stopped taking HRT, but in fact this was already established. And let’s not lose sight of how big that risk is – the answer being, as previously stated, still small.
If women experience no troubling symptoms and find they can cope with their menopause without medical assistance then all well and good. But those who feel they do need help should not be afraid to seek it.
At the moment I have a set of twins as patients – one of them took HRT and one didn’t. Both have ended up with breast cancer and the only difference between their individual situations now is that the one who was taking HRT looks years younger and has had a much better quality of life thus far.
The sad truth is some people will develop cancer irrespective of their lifestyle; nothing in life is without risk. It’s the size of the risk compared to the benefit that you always have to weigh up. That is what women need to remember.
Professor Kefah Mokbel is chairman of the multidisciplinary breast cancer programme at the London Breast Institute and a consultant oncoplastic breast surgeon at the Princess Grace Hospital in the capital.