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Breast cancer and HRT risks evaluated

Thursday October 29th 2020

New estimates of the increased risks of breast cancer associated with different hormone replacement therapy preparations in the UK are published today.

An observational study, in the latest edition of The BMJ (28 October 2020), shows that HRT use is associated with increased risks of breast cancer, particularly for older women.

But for longer-term HRT use, the increased risks are lower than those reported in a recent meta-analysis that combined the results of 24 studies, write the authors.

In today’s study, the researchers point to a noticeable decline in risks once HRT has stopped, compared with the same meta-analysis.

Researchers at the Universities of Nottingham and Oxford set out to assess the differences in risks of breast cancer associated with the individual component hormones used in HRT after a previous study showed that long-term use of HRT tablets is associated with increased risks of breast cancer, mostly due to progestogens, while a large meta-analysis reported higher than expected breast cancer risks associated with HRT.

They used QResearch and CPRD, which are two UK primary care databases linked to hospital records, to compare HRT prescriptions for 98,611 women aged 50-79 who were diagnosed with breast cancer between 1998 and 2018 with those of 457,498 women of the same age and from the same general practice who did not develop breast cancer.

They analysed risks by HRT type – assessing oestrogen only and combined oestrogen and progestogen therapy; by recent (one-five years) and past (five or more years) use; and by short-term (less than five years) and long-term (five years or more) use.

The researchers also took into account factors such as smoking, alcohol consumption, comorbidities, family history, and other prescribed drugs.

They found that 33,703 (34%) women who had been diagnosed with breast cancer and 134,391 (31%) of the controls had used HRT recently or in the past, and increased risk was associated mainly with oestrogen-progestogen treatments. However, small increases were also associated with oestrogen-only treatments.

For recent long-term users, there was a 15% associated increased risk of developing breast cancer for oestrogen-only therapy, compared with individuals who had never taken it, while there was a 79% associated increased risk for combined oestrogen and progestogen therapy.

Past long-term use of oestrogen-only therapy and past short-term use of oestrogen-progestogen were not associated with increased risk, while the risk associated with past long-term oestrogen-progestogen use was 16%.

The authors said this meant that they would expect in recent oestrogen-only users, between three – in younger women – and eight – in older women – extra cases per 10,000 women years, and in oestrogen-progestogen users between nine and 36 extra cases per 10,000 women years.

For past oestrogen-progestogen users, the results would suggest between two and eight extra cases per 10,000 women years.

Although the authors point to some limitations in the study, they say that their findings are relevant because of the large numbers involved and the use of consistent sources of “real world” primary care data.

“Our results add more evidence to the existing knowledge base and should help doctors and women to identify the most appropriate HRT formulation and treatment regimen, and provide more consistently derived information for women’s health experts, healthcare researchers, and treatment policy professionals,” they add.

Vinogradova Y, Coupland C, Hippisley-Cox J. Use of hormone replacement therapy and risk of breast cancer: nested case-control studies using the QResearch and CPRD databases. BMJ 29 October 2020

https://www.bmj.com/content/371/bmj.m3873

Tags: Cancer | Pharmaceuticals | UK News | Women's Health & Gynaecology

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