Decline in Use of Menopausal Hormones Linked with Lower Breast Cancer Rates

According to the results of a study conducted in Canada, the sharp drop in use of combined (estrogen plus progestin) hormone therapy that occurred between 2002 and 2004 was accompanied by a decrease in breast cancer incidence. These results were published in the Journal of the National Cancer Institute.

As women reach menopause and beyond, more than 80% will experience symptoms such as hot flashes, night sweats, sleep disturbance, and vaginal dryness. Estrogen, with or without progestin, is an effective treatment for many of these symptoms. Over the last several years, however, studies have raised important concerns about the health effects of menopausal hormone therapy.

In 2002, a report from the Women’s Health Initiative indicated that combined hormone therapy increased the risk of breast cancer, heart disease, stroke, and blood clots.? Use of combined hormone therapy decreased the risk of fractures and colorectal cancer, but these benefits were thought to be outweighed by the risks for most women.

After this report, use of combined hormone therapy declined markedly. Studies from several countries—including the United States—suggest that this decline in hormone use was followed by a decline in breast cancer incidence rates.

To evaluate trends in hormone use and breast cancer in Canada, researchers collected information about women between the ages of 50 and 69 who participated in the National Population Health Survey between 1996 and 2006.

Between 2002 and 2004, the percent of women who used combined hormone therapy decreased from 12.7% to 4.9%. During this same period, the rate of breast cancer declined.Since 2005 there has been some rebound in breast cancer rates. This suggests that avoidance of hormone therapy may act primarily by slowing the growth of breast cancer (rather than preventing breast cancer). Mammography rates remained stable throughout the study period.The study did not have information about the hormone receptor status of the breast cancers that were diagnosed, nor was information available about duration of hormone use.

The researchers conclude that between 2002 and 2004, a decline in hormone therapy use in Canada was accompanied by a decline in breast cancer incidence.

Additional research is warranted to determine the biologic link between hormone therapy and breast cancer. The results of the current study suggest that combined hormone therapy may speed the growth of breast cancers.

Reference: De P, Neutel I, Olivotto I, Morrison H. Breast cancer incidence and hormone replacement therapy in Canada. Journal of the National Cancer Institute [early online publication]. September 23, 2010.

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Additional Research on Menopausal Hormone Therapy and Breast Cancer

A recent study of menopausal hormone therapy and risk of breast cancer reported that risk may vary by body weight and the type of hormone therapy. These results were published in Cancer Epidemiology, Biomarkers, & Prevention.

As women reach menopause and beyond, more than 80% will experience symptoms such as hot flashes, night sweats, sleep disturbance, and vaginal dryness. Estrogen, with or without progestin, is an effective treatment for many of these symptoms. Over the last several years, however, studies have raised important concerns about the health effects of menopausal hormone therapy.

Use of estrogen plus progestin has been linked with an increased risk of heart disease, breast cancer, stroke, and blood clots and a decreased risk of fractures and colorectal cancer. Use of estrogen alone, which is generally reserved for women who have had a hysterectomy, has been linked with an increased risk of strokes and a decreased risk of fractures.

Although it is now well established that menopausal hormone therapy with estrogen plus progestin increases the risk of breast cancer, researchers continue to explore the question of which subgroups of women are at greatest risk. This information would help personalize messages about the risks and benefits of hormone therapy.

The current study evaluated information from the California Teachers Study. Of the more than 56,000 perimenopausal or postmenopausal women in the study, 2,857 developed invasive breast cancer during 10 years of follow-up.

Compared with women who had never used hormone therapy, women who had used estrogen alone for 15 years or longer had a 19% increased risk of breast cancer (A 19% increase in risk means that if a woman has a 5% risk of getting breast cancer in the next 20 years, the risk goes up to 6%.). Women who had used estrogen plus progestin for 15 years or longer had an 83% increased risk of breast cancer (An 83% increase means that if a woman has a 5% risk over 20 years, the risk goes up to approximately 9%).For users of estrogen plus progestin, risk varied by the specific type of regimen used. Continuous regimens (progestin every day of the month) appeared to increase breast cancer risk to a greater extent than sequential regimens (progestin only some days of the month).The increased risk of breast cancer among users of hormone therapy was most apparent among thinner women.Use of hormone therapy increased the risk of cancers that were estrogen receptor-positive and progesterone receptor-positive.

These results provide additional evidence regarding the links between menopausal hormone therapy and risk of breast cancer. Women who are considering hormone therapy to manage menopausal symptoms are advised to talk with their doctor about the risks and benefits.

Reference: Saxena T, Lee E, Henderson K et al. Menopausal hormone therapy and subsequent risk of specific invasive breast cancer subtypes in the California Teachers Study. Cancer Epidemiology, Biomarkers, & Prevention [early online publication]. August 10, 2010.

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Study Explores Non-Drug Treatments for Menopausal Symptoms

Exercise and cognitive behavioral therapy may reduce menopausal symptoms among young women who have been treated for breast cancer. These results were presented at the eighth European Breast Cancer Conference (EBCC-8).????

For women with breast cancer, treatments such as chemotherapy and hormonal therapy can be life-saving. Side effects, however, may include the sudden and early onset of menopausal symptoms. When severe, symptoms such as hot flashes, night sweats, and vaginal dryness can have a profound effect on quality of life.????

To explore non-drug approaches to managing menopausal symptoms in young women with breast cancer, researchers in the Netherlands conducted a study among 422 women with an average age of 48. The researchers assigned women to one of four groups:????

Cognitive behavioral therapy?Physical exercise?Cognitive behavioral therapy AND physical exercise?None of the above (this was the control group)?

Cognitive behavioral therapy consisted of six weekly group sessions. The sessions included relaxation exercises, and focused primarily on hot flashes and night sweats. ?

The exercise program was a 12-week, home-based program. Women were asked to exercise for 2 ? to 3 hours per week at a level that allowed them to reach a target heart rate.?

Women who received one of the interventions (exercise or cognitive behavioral therapy or both) experienced an overall decrease in menopausal symptoms, along with improvements in sexual and physical functioning. These benefits were still apparent six months later.????

For women who are not able to take estrogen to manage menopausal symptoms, or who choose not to take estrogen, finding effective, non-hormonal approaches to managing menopausal symptoms is important. The current study reports on two promising approaches: regular physical activity and structured cognitive behavioral therapy.????

Reference: Oldenburg HSA, Duijts SFA, van Beurden MM et al. Efficacy of cognitive behavioral therapy and physical exercise in alleviating treatment-induced menopausal symptoms in patients with breast cancer- results of a randomized controlled multicenter trial. Paper presented at: eighth European Breast Cancer Conference (EBCC8); March 21-24, 2012; ?Vienna, Austria. Abstract 199.?

Posted March 29, 2012

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