HRT still a matter of balancing risk

A NEW Lancet study showing a small increased risk of breast cancer with hormone replacement therapy (HRT) is in keeping with existing NICE guidance on the treatment of menopausal symptoms, according to both the Royal College of Obstetricians and Gynaecologists and the British Menopause Society.

Professor Janice Rymer, consultant gynaecologist and vice president of the RCOG, said: "Women and doctors should be reassured that the findings of this study do not add anything new in terms of the effects of hormone replacement therapy. Research shows that, for most women, HRT helps to manage menopausal symptoms and is safe."

A joint RCOG/BMS statement points out that the overall findings are in keeping with The National Institute for Health and Care Excellence (NICE) guidance on treatment of menopausal symptoms which notes a small increased risk of breast cancer associated with HRT.

The Lancet review covered a 26 year period to January 2018 and included data from 58 studies of 108,647 postmenopausal women who developed breast cancer, of which 55,575 (51 per cent) had used HRT. The report showed an increase in the risk of breast cancer with HRT intake. The risk was found to be higher with combined oestrogen/progestogen compounds, but was also increased, although to a lesser extent, with oestrogen-only systemic HRT.

The risk of breast cancer remained elevated for more than 10 years after discontinuing HRT and this appeared dependent on the duration of HRT use. Starting HRT between the age of 40 and 50 was also associated with an increased risk of breast cancer, but the number of women in this sub-group was relatively small.

Professor Rymer further commented: "The findings from this research should be helpful to both women and doctors, particularly around when considering whether to start hormone therapy, for how long and which preparation they could take – whether it includes oestrogen and progestogen combined, or oestrogen alone. 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."