Does Hormone Replacement Therapy Increase the Risk of Breast Cancer?
Joylux welcomes guest blogger Dr. Frank J. DellaCroce, MD, FACS, founding partner of the Center for Restorative Breast Surgery and St. Charles Surgical Hospital, the first hospital in the world dedicated to breast reconstruction for women affected by breast cancer.
Perimenopause and menopause are a transition to a new phase of life. During this natural process, hormone levels change, and your body experiences frustrating symptoms such as hot flashes, mood changes, and sleep interruptions.
Declining estrogen levels are directly linked to changes including vaginal dryness, pain with intercourse, and decreased sexual interest. While these symptoms are part of a woman's natural process of aging, there are many tools that can help manage these uncomfortable changes.
If you are dealing with the uncomfortable effects of menopause, your doctor may recommend hormone replacement therapy (HRT). If you have a history of breast cancer or you’re at increased genetic risk of this common cancer, you may have heard about the risks that HRT can pose. We’ll take a closer look at the interaction between HRT and breast cancer risk, and what it means for you.
What is HRT?
HRT is used to reduce frustrating menopausal symptoms such as hot flashes, osteoporosis, vaginal dryness, and mood changes. The main goal of this treatment method is to boost your hormone levels and minimize the symptoms of menopause.
There are two primary types of HRT your doctor can recommend for you:
- Estrogen Therapy: Your doctor can prescribe estrogen therapy as a vaginal ring, spray, cream, or gel. The treatment regimen contains variable doses of synthetic estrogen. It is most recommended for women who have undergone a hysterectomy (surgery that removes your uterus). Estrogen is quite beneficial in reducing menopausal symptoms such as hot flashes but predisposes you to uterine cancer.
- Estrogen and Progestin Therapy: It is a combination therapy with equal levels of estrogen and progestin. It is primarily recommended for women who have not undergone a hysterectomy. The combination pill minimizes the risk of uterine cancer.
What are the Health Risks of HRT?
When selecting HRT as a method to manage menopausal symptoms, it is imperative to weigh the benefits and risks of this method. According to research, HRT increases the risks of breast cancer, pulmonary embolism, and stroke, among others.
Clinical Trials Indicate that HRT Increases Risk of Breast Cancer
Although HRT is very effective in reducing menopausal symptoms, it can highly increase the risks of breast cancer. It also increases the chances of breast cancer recurrence for women diagnosed with this type of cancer. Due to the potential risks, most doctors recommend that women with a history of breast cancer refrain from using HRT.
However, it is imperative to note that the risk of breast cancer will depend on multiple factors such as:
The type of HRT you are using
Women using the combination therapy of HRT, which has both estrogen and progestin, are at a higher risk of breast cancer. Initially, a study of over 16,000 women, called The Women’s Health Initiative, published in 2002 showed that women taking combination therapy had a slight but definite increase in breast cancer risk as well as increases in stroke, hip fractures and pulmonary embolism. An increase in the risk of breast cancer was not seen in women taking estrogen alone. Follow-up studies including a 2020 study showed estrogen-only HRT has minimal chances of increasing breast cancer and will only increase after using it for more than ten years.
Duration of HRT Use
Using HRT for more than one year significantly increases the chances of breast cancer. According to National Institute for Health and Care Research, women taking HRT for less than one year have a reduced risk of breast cancer. According to another research done in 2020, the risk of breast cancer will increase if you take HRT for a longer duration.
Age of HRT Use
The age of a woman also significantly determines the risk of breast cancer. According to the same research findings by the National Institute for Health and Care Research, women aged 50 were at a lower risk of developing breast cancer. However, women in their 60's and 70's were at very high risk.
Is HRT Safe for People with a History of Breast Cancer?
HRT increases the risk of breast cancer recurrence and is not recommended for people with a previous history of breast cancer. If you have been diagnosed with breast cancer before, you should talk with your doctor about the best alternative. If you have inherited the breast cancer gene, BRCA1 or BRCA2, it is best to consult your doctor about HRT's benefits and risks.
What are the Alternatives to HRT?
Multiple herbal supplements available in the market claim to help minimize menopausal symptoms. However, it is paramount to note that the word herbal does not always mean that the herbal preparations are safe. Unfortunately, the Food and Drug Administration (FDA) does not regulate herbal supplements, and you should be cautious when using them.
Exercises are another natural method to deal with stressful menopausal symptoms. Various exercises can help regulate your blood sugar levels and give you robust strength. Ideally, exercises help to ensure your bones are strong and minimize the chances of osteoporosis. They can also help improve sleep quality and minimize hot flashes. Weight-bearing exercises are the most recommended as they work efficiently to improve bone strength.
In the perimenopausal and menopausal phases, you must be cautious about your food. Eating foods with a high sugar content will significantly increase unpleasant symptoms. If you don't drink enough water and your body is dehydrated, it will also increase the chances of hot flashes. It’s essential to strive for a healthy diet and avoid too many refined or processed foods.
Since osteoporosis is a significant challenge during this phase, you can avoid that by eating foods rich in vitamin D and calcium. These nutrients will ensure that your bones remain strong.
Additionally, stimulants such as tea and coffee increase hot flashes and should be avoided. Spicy foods are also linked to hot flashes and should be regulated.
In stressful situations, your body tends to produce adrenaline and cortisol. The adrenal glands become overwhelmed, leading to more suppression of estrogen production. Production of less estrogen means that your body suffers more severe menopausal symptoms. It’s important to ensure you manage your stress levels during this transitional period.
Red LED light devices, such as Joylux's vFit Gold, help to promote muscle strength and tissue suppleness, leading to improved natural hydration, more sexual sensation, and a healthy pelvic floor.
A Doctor’s Perspective
My practice is dedicated exclusively to the care of women affected by breast cancer. In the last 20 years, we have worked tirelessly to advance reconstructive plastic surgery outcomes for those facing mastectomy. In that same period, there have been many wonderful and encouraging developments that have improved outcomes across the board.
Improved imaging technology, earlier detection, improved therapies, advanced surgical techniques, and a greater focus on the functional and aesthetic outcomes after mastectomy have revolutionized breast cancer care.
Despite the improvements, one issue is often little-discussed and solutions have been lacking. This centers around the fact that the majority of breast cancers are hormone sensitive. That means that some of the most effective drugs used to battle breast cancer and prevent recurrence do so by blocking female hormones. These “estrogen blockers” and some of the chemotherapy drugs used to treat breast cancer can leave women in a sudden and complete menopausal state. Most women aren’t prepared for this and the lack of quality solutions has been a point of frustration for patients and their caretakers for a long time.
As a Plastic Surgeon, my role in the breast cancer arena is to restore wholeness, provide hope, and a pathway to return to a high quality of life after the treatments are over. To finally have a meaningful product line to offer my patients who are suffering from the effects of pre-mature menopause has been fantastic and far more than well-received. The complete JoyLux product line is now a standard part of the overall holistic treatment options for the women we take care of at our Center. Thank you Joylux!
Dr. Frank J. DellaCroce, MD, FACS
Director of the Center for Restorative Breast Surgery
New Orleans, LA
There are significant flaws in the 2002 WHO study. Synthetic progestins act differently from bio-identical progesterone in the body. For example, bio-identical progesterone is often prescribed to pregnant women who are at risk of miscarriage. Synthetic progestins are contraindicated in pregnancy.
It is still largely unknown if natural progesterone increases cancer risks like synthetic progestins do, but it is very premature (and potentially harmful to women in need of hormone therapy) to blindly apply those risks based on that flawed WHO study that many physicians have taken issue with. From what I understand the study has been modified to reflect this discrepancy.