Hormone Replacement Drugs Linked to Cancer and Death

Reported by: Newsroom Solutions
Wednesday, October 20, 2010


A new study has found women taking hormone replacement drugs develop more advanced breast cancers.

They are also more likely to die from the disease than women who weren't on hormone replacement therapy.

The study is the first to report a higher number of breast cancer deaths among women taking hormone therapy.

It contradicts earlier studies that suggested women taking hormone replacement pills had less aggressive cancers.

The findings are published in the "Journal of the American Medical Association."  

INTRODUCTION

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Despite the well-documented effects of hormone replacement therapy (HRT) on reducing menopausal symptoms,¹ and risk of osteoporosis,² and a potentially beneficial effect on the primary prevention of coronary heart disease,^3-4 concerns about breast cancer cause many women to avoid taking estrogens. Recent studies demonstrating that the selective estrogen receptor modulators tamoxifen⁵ and raloxifene⁶ reduce the incidence of hormone receptor–positive breastcancer have focused new attention on associations between hormones and breast cancer risk.

Whether HRT use increases risk of breast cancer is controversial. A considerable amount of epidemiological data supports a modest increase in risk of breastcancer with long-term hormone use. For example, in a combined analysis of 51 studies, the relative risk (RR) of breast cancer was 1.35 (95% confidence interval [CI], 1.21-1.49) for women who used HRT for 5 years or more compared with never-users.⁷ However, Shairer et al⁸ proposed that postmenopausal hormone exposure specifically promotes the growth of less aggressive, slow-growing tumors. Although two^8-9 of three¹⁰ studies reported differences in the association between HRT use and risk of invasive vs in situ breast cancer, it hasnot been determined whether the effect of HRT use on breast cancer incidence varies among histological types of invasive carcinomas. Clinically, significant differences in prognosisexist between infiltrating ductal and lobular carcinomas, which account for 85% to 90% of invasive tumors,^11-12 and the less common medullary, papillary, tubular, and mucinous tumors that have a lower risk of axillary node metastases and a more favorable prognosis.^12-13 Information regarding differences in HRT-associated risk across histological types of breastcancer could have implications for determining the risks and benefits of hormonally related disease prevention strategies.

Using data from a large cohort of postmenopausal women, we examined whether the association between HRT use and breast cancer incidence differs among 3 histologically defined groups of breast tumors: ductal carcinoma in situ (DCIS), invasive carcinomas with favorable histologies, and invasive ductal and/or lobular carcinoma.


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