NEJM Article on Breast Cancer and HRT
NEJM Article on Breast Cancer and HRT - Comment by
International Menopause Society
Introduction
The New England Journal Of Medicine will publish an article by Chlebowski and colleagues on Thursday 5th February 2009, entitled Breast Cancer after Use of Estrogen plus Progestin in Postmenopausal Women (Volume 360:573, February 5, 2009, Number 6). The article below is a commentary produced on behalf of the International Menopause Society by Professor Samuel Shapiro and Professor Anne Gompel, based on the initial results which Chlebowski et al presented at the San Antonio Breast Cancer meeting in December. The comments also apply to the NEJM paper, but please note the additional comment immediately before the references. In brief, the statement says:
- The decline in breast cancer rates started at least 3 years before the WHI study was halted (which led to a dramatic drop in HRT use). This implies that the decline in breast cancer rates must be independent of the drop in HRT use.
- Breast cancer takes years to develop and, to reach the stage where it is detectable, it takes at least a decade. If HRT use causes breast cancer, then the drop in breast cancer rates would not be seen for some time yet.
- There is no doubt that there has been a drop in breast cancer rates, but this could easily be due to other factors, e.g. a change in screening protocols (see below).
Commenting, Dr David Sturdee (Solihull, UK), President of the International Menopause Society said:
"There is no doubt that there has been a drop in breast cancer rates, which is very good news, but this started before the reduction in HRT use. In addition, breast cancer takes years to develop, so if this drop was due to stopping HRT, we just wouldn't be seeing the drop just yet. There's something happening, which is worth investigating, but it's unlikely to be Hormone Replacement Therapy. Our advice remains the same. Each woman is an individual, each woman should speak to her clinician to see if HRT is right for her, especially if she's older than 60. But for most women going through the menopause, there's not a problem".