Hormone Replacement Therapy and Risk of Breast Cancer With a Favorable Histology

The relationship of breast cancer and hormone replacement therapy as best as can be determined by all available studies was the subject of an excellent article, "Breast Cancer and Hormone Replacement Therapy", recently discussed here on OBGYN.net by Dr. Ronald Barentsen, chairman of the Menopause Editorial Advisory Board. To review, the recent article in the Lancet that he discussed showed that there was a very small increased risk of breast cancer by taking hormones over a prolonged length of time. However, certainly this risk should be viewed in the overall context of risks and benefits. Women who choose not to take replacement hormones undoubtedly place themselves at a significantly increased risk of heart disease, osteoporosis, and possible senile dementia. These are all facts that women should consider when making their own personal decisions regarding whether or not to take replacement hormones. Women also have other components to their decision, and no two women have the same feelings and concerns, not to mention family histories and risk factors. No one can argue that no woman wants to have breast cancer, and even if one could say the risk is only one in a million, it really does not matter what the numbers are if you are that one! On the other hand, everything we do in life carries risk and benefits. A person can be guaranteed she will never be involved in a car wreck by locking herself in her house the rest of her life, but who wants to do that? So every time she leaves her house she accepts that risk in order to obtain the benefits of being mobile. That is an exaggerated comparison, but underscores the fact that everything we do and every action we take, negative or positive, has risks and benefits. We just accept the risks in order to obtain the benefits of our action. Any decision of this type, and certainly the decision as to whether or not to take hormone replacement therapy, should be based on as much facts and information as a woman can accumulate for herself, and then made on an individual basis.

A recent article in the Journal of the American Medical Association (JAMA) adds some important new information for women to consider when making this important decision in their life. Dr. Susan Gapstur of Northwestern University and her colleagues studied the effects of long term use of estrogen in 37,105 women. The study extended over a ten year period from 1986 to 1996, and included women from 55 to 69 years of age. There were a total of 1520 cases of breast cancer in this group of women. The very interesting thing the study showed was that the types of cancer that seemed to occur as a result of the long term use of estrogen tended to be the ones with the most favorable prognosis. That is, if a cancer does occur as a result of the use of estrogen, then it usually is a kind that is much more easily treated and cured. While the authors readily admit that more research is needed to more clearly elucidate this finding, at least it is an encouraging addition to the facts a woman should consider when making this decision.

If one goes back to the car wreck analogy, then that is a risk that anyone accepts when leaving their house. While no one wants to be in a car wreck either, there is certainly an overall difference in the risk from a car wreck in the Indianapolis 500 versus one driving at 20 miles per hour going to the store. Perhaps the seriousness of a potential car wreck would change her decision regarding when, and even whether, to leave the house. The lessened seriousness of the type of breast cancer which may be associated with hormone replacement therapy may also become another part of the facts every woman should consider when making this very important decision in her life.