Hormone Replacement Therapy And Breast Cancer

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HORMONE REPLACEMENT THERAPY AND BREAST CANCER: THE RISKS IN PERSPECTIVE

Janet M., a fifties-something woman, entered my office and said as she sat down, "I've read that if I take hormones I'll increase my breast cancer risk. I'm going crazy without sleep and with these mood swings, but I don't want to increase my breast cancer risk by taking hormones."

Like many women, Janet had heard that a recent study, the Women's Health Initiative (WHI), definitively showed that hormone replacement therapy (HRT) increases breast cancer risk. Janet, like most people, didn't realize that this study found no statistically significant increase in breast cancer risk to women who took HRT.

When differences are not significant, an increase in risk may well be due to other factors, not the one being studied, such as HRT use. As often happens when a medical story is reported, the emphasis was on the increase in risk, not whether the increase was likely to be due to the agent being studied or to the size of the risk.

The actual size of a risk is important in any woman's decision making process. In this case the risk was exceedingly small -- only 8 in 10,000 women a year -- which is 0.08% or eight hundredths of one percent! Janet was amazed to learn the actual size of the increase, and said, "You mean I was getting all concerned for a risk that small!"

"And," I pointed out, "even this very small difference in risk may not be due to hormone use." I explained that breast cancers take an average of eight years to reach about half an inch in size. This means that breast cancers started in the first year of the study would not be detected for eight or more years. The study followed women for only about five years, so all or most of the breast cancers found were probably present in an undetected state before the study began.

Janet asked if HRT use might have caused some breast cancers to grow more rapidly and therefore be detected sooner than eight years. This is unlikely. A number of studies find that breast cancers in women who were using HRT were not larger and were not dividing more rapidly than breast cancers in non hormone users. Since breast cancers grow more slowly in older women and the average age in this study was 63, breast cancers in this group would tend to grow more slowly and so take even longer than the eight year average to be detected.

Women in the WHI study used a particular type of hormone Prempro. The results of this study therefore do not apply to other, newer approaches in which more natural hormones are used and a woman's menstrual cycle is more closely approximated.

Janet was surprised to learn that many studies find that women who use HRT do not have an increase in breast cancer risk compared to women who don't use hormones, even when hormones are used for twenty years. Also, in another large study in which some women were assigned to take Prempro and others not, women who used Prempro had no significant increase in breast cancer risk.

Of Lumps, Bumps And Breast Cancer

You feel a mild soreness in the breast so you checked for lumps. You felt a little bump. The next best step is to consult a doctor, you might have breast cancer. Breast cancer is a malignant tumor that starts from the cells of the breast. Breast cancer occurs mainly in women but this does not mean that men are safe from this disease.

A woman's breast is made up of lobules, which are glands that make the milk; ducts, which connect lobules to the nipples; fat and connective tissues; blood vessels; and lymph vessels. Most breast cancers begin in the ducts. It may also begin in the lobules then spread to other tissues.

When one feels a lump in the breast, there is really no virtual worry because most lumps are benign which means that they are not cancerous. In fact, benign breast tumors are abnormal growths but do not really pose threats because they do not spread outside of the breast. However, some benign lumps increase the risk in having breast cancer.

Then there are lumps that are not really tumors at all which are often caused by fibrocystic changes -- cysts are fluid-filled sacs while fibrosis is the formation of scar-like tissue. These changes can cause swelling of the breasts resulting to being lumpy and sometimes a fluid discharge from the nipples.

There are different types of breast cancer and knowing them will greatly help in assessing the disease.

Carcinoma in situ is a term used for early stage of breast cancer where the cancer cells are still confined to the place where it started. In particular, the cancer cells are confined in the lobules or the ducts, depending on where it started. The cancer cells have not gone into the fatty tissues in the breast nor spread to other organs of the body.

Ductal carcinoma in situ is the most common type of noninvasive breast cancer. Similar with Carcinoma in situ, the cancer cells have spread through the walls of the duct into the fatty tissue of the breasts. Almost all women with breast cancer at this stage can be cured and the best way to find is through the use of mammogram.

Lobular carcinoma in situ is the condition which begins in the milk-making glands but does not go through the walls of the lobules. This is not a true cancer but this can increase the risk of a woman to have breast cancer later. For this very reason, it is of utmost importance for women with this type of condition to follow the guidelines for breast cancer.

Infiltrating (or invasive) ductal carcinoma is a type of breast cancer that starts in the milk passage, breaks through the duct walls, invades the fatty tissue of the breast then spread to other parts of the body. This is the most common type of breast cancer.

Infiltrating lobular carcinoma starts in the milk glands then travel to the other parts of the body.

As of now, there is no exact cause for breast cancer but there are certain factors that are linked to the disease. Some factors that cannot be controlled are age, gender, family history, personal history of breast cancer, and race. Factors such as not having children, birth control pills, diet, exercise, and alcohol are some of the factors that can be controlled which may lessen or heighten the risk of a woman to have breast cancer.

There are several tests that may confirm and disconfirm if you suspect breast cancer such as imaging tests which includes mammography, breast ultrasound, and ductogram and biopsy which includes fine needle aspiration biopsy, stereotactic core needle biopsy, and surgical biopsy.

Hormone Replacement Therapy: Breast Cancer Risk In Perspecti

Many women have concluded that recent study results show that hormone replacement therapy increases breast cancer risk. A closer look at this study shows that the increase in risk was far less than half a per cent a year and may not be due to hormone
Janet M., a fifties-something woman, entered my office and said as she sat down, "I've read that if I take hormones I'll increase my breast cancer risk. I'm going crazy without sleep and with these mood swings, but I don't want to increase my breast cancer risk by taking hormones."

Like many women, Janet heard that a recent study, the Women's Health Initiative (WHI), definitively showed that hormone replacement therapy (HRT) at menopause increases breast cancer risk. Janet, like most people who heard about this study, didn't realize that the WHI study found no statistically significant increase in breast cancer risk to women who took HRT.

When differences are not significant, an increase in risk may well be due to other factors, not the one being studied, such as HRT use. In this, as in the reporting of many studies, the emphasis was on the increase in risk, not whether it was likely to be due to the agent being studied or to its size.

In addition to statistical significance, the actual size of a risk is important in any woman's decision making process. In this case the risk was exceedingly small - only 8 in 10,000 women a year - which is 0.08% or eight hundredths of one per cent! Janet was amazed to learn the actual size of the increase, and said, "You mean I was getting all concerned for a risk that small!"

"And," I pointed out, "even this very small difference in risk may not be due to hormone use." I explained that breast cancers take an average of eight years to reach about half an inch in size. This means that breast cancers starting in the first year of the study would not be detected for eight or more years. The study followed women for only about five years, so all or most of the breast cancers found during the study were probably present in an undetected state before the study began.

Janet asked if HRT use might have caused some breast cancers to grow more rapidly and therefore be detected sooner than eight years. This is unlikely. A number of studies find that breast cancers in women who were using HRT were not larger and were not dividing more rapidly than breast cancers in non hormone users. Also, breast cancers grow more slowly in older women. The average age in this study was 63, so breast cancers in this group would tend to grow more slowly and so take even longer than the eight year average to be detected.

Women in the WHI study used a particular type of hormone called Prempro. The results of this study therefore do not apply to other, newer approaches in which more natural hormones are used and a woman's menstrual cycle is more closely approximated.

Janet was surprised to learn that in many studies women who use HRT do not have an increase in breast cancer risk compared to women who don't use hormones, even when hormones are used for twenty years. Also, in another large study in which some women were assigned to take Prempro and others not, women who used Prempro had no significant increase in breast cancer risk.

As Janet left, she said, "I can see now that when I hear about a study I need to know how big a risk is, and not just that it is increased. I'll also ask how long a study it was. This discussion has given me a whole different perspective."