To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: Breast Cancer Risk With HRT Is Small, Says Canadian Ob/Gyn Society URL: http://www.pslgroup.com/dg/16CE1E.htm Doctor's Guide February 21, 2000
OTTAWA, ON -- February 21, 2000 -- The Society of Obstetricians and Gynaecologists of Canada (SOGC) has reviewed data published in the January 25th edition of the Journal of the American Medical Association (JAMA) from the National Cancer Institute's Breast Cancer Detection Demonstration Project (BCDDP), showing a slight increased risk of breast cancer associated with long-term use of hormone replacement therapy. This risk has been reported in previously published studies. Unfortunately, the results as presented in this study only adds to the complexity and uncertainty surrounding the issue of breast cancer and hormone replacement therapy (HRT). At this time, the SOGC believes it is essential to restate the facts on the risks of hormone replacement therapy within the appropriate context. In 1998, the SOGC published a consensus on menopause and osteoporosis which was based on the best scientific evidence available. This study shows that, based on a recent meta-analysis of over 50 epidemiological studies published on the risk of breast cancer with hormone replacement therapy, current users of HRT, or those who ceased one to four years previously, had a small increased relative risk of breast cancer. The combined analysis reported no increased risk for HRT users of less than five years. For women who had used HRT for five years or longer, the average relative risk of breast cancer increased by approximately two percent per year of use. This reported relative risk for breast cancer with HRT would account for an excess of two, six or 12 cases per 1,000 HRT users after five, ten or 15 years of use, respectively. Within five years of discontinuation of HRT use, the increased relative risk virtually disappeared. There is a greater risk of developing breast cancer due to excessive alcohol consumption or by failure to exercise regularly than that attributable to HRT. In fact, the risk of developing breast cancer increases by 60 percent if alcohol consumption exceeds 2 drinks per day, by 60 percent if a woman does not exercise, by 2.8 percent for each year menopause is delayed and by only 2.3 percent by year of use of hormone replacement therapy. Age is also a risk factor. It is therefore important to note that the increased risk as reported is therefore extremely small, particularly when compared with other known risk factors. Canadian women who have reached menopause are at a greater risk of developing other diseases, such as cardiovascular disease, if they don't take hormone replacement therapy. Heart disease is the number one killer of women in this age group. Hormone replacement therapy not only protects women after menopause from developing heart disease, but also provides protection against osteoporosis (which afflicts one in four women over the age of 50), as well as colorectal cancer. "The SOGC believes that the implications for women are similar to those of other studies: women should discuss the potential benefits and risks of hormone replacement therapy with their health care provider based on their individual health needs and personal risk factors for such things as cancer, osteoporosis and heart disease'' stated Dr. André Lalonde, Executive Vice-President of the SOGC. "A woman may not need to take hormone replacement therapy indefinitely, and should reassess her needs with her health care provider on a regular basis'' added Dr. Lalonde. An element in the BCDDP study is the somewhat greater, but still small risk of breast cancer diagnosis with estrogen-progestin use compared with estrogen alone. Because the subjects were surveyed over the past 20 years, they could have been on higher doses and different regimens of estrogen-progestin than are commonly prescribed today. The results, therefore, may not be reflective of current lower-dose therapies. Questions raised by the BCDDP study point to the need for further investigation. More definitive answers are anticipated in 2006 at the conclusion of the National Institute of Health: Women's Health Initiative, a randomized, double-blind, clinical trial which is studying benefits or risks of estrogen and progestin on the bone, heart, breast and other tissues. Related Links: hormone replacement therapy (HRT) and Journal of the American Medical Association (JAMA). --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. 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