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HRT and cancer:

Balancing safety and quality of life

Opinions on the risks and benefits of hormone replacement therapy vary widely among woman and their physicians. Sandra Shuman feels that HRT contributed to the estrogen-sensitive breast cancer she developed in 2000. With her cancer treated by lumpectomy and radiation, Shuman takes an estrogen-blocking drug to prevent recurrence. She also uses complementary therapies such as diet and supplements and say she feels better at 62 than she did at 52.

Opinions on the risks and benefits of hormone replacement therapy vary widely among woman and their physicians. Sandra Shuman feels that HRT contributed to the estrogen-sensitive breast cancer she developed in 2000. With her cancer treated by lumpectomy and radiation, Shuman takes an estrogen-blocking drug to prevent recurrence. She also uses complementary therapies such as diet and supplements and say she feels better at 62 than she did at 52.

Rock or hard place? Before last summer, this seemed to be the choice for women entering menopauseand considering hormone replacement therapy (HRT). If they took HRT — an oral combination of estrogen and progestin to ease symptoms of menopause — they might increase their risk for breast cancer. If they did not take the medications, doctors said, they would be more prone to heart disease and osteoporosis. The comfortable place these women sought was freedom from the symptoms that HRT is intended to relieve: hot flashes, night sweats, insomnia, and vaginal dryness.

For the average woman, this decision became even more difficult last July, when the results of a major study of HRT were published, setting off a torrent of publicity. Conducted under the Women's Health Initiative (WHI) and supported by the National Institutes of Health, it was the first randomized, controlled study to confirm what previous studies had suggested: that the standard HRT drug does raise the risk of breast cancer. The study also established that HRT can protect women from osteoporosis. But the greatest surprise was that it failed to confirm the supposed benefit of reducing heart disease, and even found an increased risk of heart attacks and strokes.

For patients in the Women's Cancers Program at Dana-Farber, the HRT decision is more complicated than for the average woman — and the stakes are higher. These women are at risk for developing cancer or have already been diagnosed with cancer, and they come to Dana-Farber with a battery of unique questions.

Turning Point, Winter/Spring 2003

Turning Point Archive

What do the numbers mean?

"It is important for women who read about the Women's Health Initiative (WHI) study to interpret the numbers correctly because a misunderstanding can be alarming," says J. Dirk Iglehart, MD, director of the Women's Cancers Program.

Women using hormone replacement therapy had a 26 percent higher incidence of invasive breast cancer (8 in 10,000) than the women who did not use HRT. This means that if 1,000 women took the medication for 10 years, there would be 8 more cases of breast cancer in this group than among women who did not.

On the other hand, women using HRT had a 37 percent lower incidence of colon cancer (6 in 10,000) than the women who did not use HRT. This means that if 1,000 women took the medication for 10 years, there would be 6 fewer cases of colon cancer in this group than among women who did not use this therapy.