Breast cancer and hormone-replacement therapy: up to general practice to pick up the pieces

Abstract

Hormone-replacement therapy (HRT) as a health issue for women has triggered heated discussions since promotion of the treatment in the mid-1970s. 1 Wilson RA Feminine forever. M Evans and Company Inc, New York1966 Google Scholar Projected benefits were symptom relief, enhanced self-esteem and quality of life, prevention of cardiovascular disease, and improved bone-mineral status. These projections positioned HRT as being beneficial for all women in their sixth and seventh decade. Arguments against HRT formed a mixed bag: ideological (should a normal phase of life be medicalised by defining menopause as a disease?); doubts about the cardiovascular protection; and concerns about risks (cancer, thrombotic events). The Million Women Study in today's Lancet fuels this discussion with new and convincing data. The findings are in line with two recent publications 2 Chlebowski RT Hendrix SL Langer RD et al. Infludence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women. JAMA. 2003; 289: 3243-3252 Crossref PubMed Scopus (1660) Google Scholar , 3 Li CI Malone KE Porter PL et al. Relationship between long durations and different regimens of hormone therapy and risk of breast cancer. JAMA. 2003; 289: 3254-3263 Crossref PubMed Scopus (357) Google Scholar on oestrogen-progestogen replacement therapy, which reported increased incidences of advanced or invasive breast cancer. Breast cancer and hormone-replacement therapy in the Million Women StudyCurrent use of HRT is associated with an increased risk of incident and fatal breast cancer; the effect is substantially greater for oestrogen-progestagen combinations than for other types of HRT. Full-Text PDF