HRT benefits 'outweigh the risks'

Current medical opinion seems to be that the benefits of hormone replacement therapy (HRT) "outweigh the risks of breast cancer," says Auckland breast physician Dr Jackie Blue.

She says it is little wonder that women may be cautious about starting a course of HRT, since some world studies have previously shown that it can increase the risk of getting breast cancer by up to 35 per cent.

Yet, she says, "current research is coming up with some interesting new facts about the effects of HRT use, and oestrogen generally. And current opinion seems to be that the benefits outweigh the risks."

At an international conference on menopause recently, Dr Blue looked to two world experts for the answers - Dr Dawn Willis of the American Cancer Society and Professor Leon Speroff from the Oregon Health Sciences University. Dr Willis is involved in a huge cancer prevention study in the United States.

Dr Blue says that Dr Willis acknowledges that HRT increases a woman's chances of developing breast cancer. But the study results, she says, point to a significant reduction in deaths from all forms of cancer, particularly from bowel cancer, when women have used oestrogen to help them through the menopausal years.

Professor Speroff, she says, has reviewed all the data available on HRT. He "notes that breast cancers developed by women on HRT tend to be more localised and less aggressive than those diagnosed in non-users."

He also feels that the increased breast cancer risk seen in women on HRT could be related to the fact that HRT may stimulate the appearance of a pre-existing breast cancer at an earlier stage, by growing at a faster rate without being more aggressive. "It's interesting that further down the track HRT appeared to protect women from developing breast cancer," Dr Blue says.

She adds that while Professor Speroff's theories are not proven, analysis of the current data supports the conclusion that breast cancer death rates are lower in HRT users and that women using oestrogen have a smaller chance of dying of other forms of cancer, including lung and bowel cancer.

"Both Dr Willis and Professor Speroff recommend an annual mammogram for women from 40 years of age, because the earlier a cancer is detected the more successful any treatment will be."

As yet, Dr Blue says, there is no single answer to the question of breast cancer risk in relation to HRT.

"Each woman must weigh up the risks and benefits for herself," she says. "We believe that a woman should have all the facts on HRT she needs, so she can feel confident about making an informed decision."