I have written on this subject before, but a recent report published in the medical journal JAMA on February 13, 2002, has concluded that hormone replacement therapy (HRT) increases risk for breast cancer. In the study mentioned, investigators evaluated whether risk for HRT-associated breast cancer differs by histological type (area of breast affected). The results showed that risk for breast cancer was 60% to 85% higher in women who used oral estrogen alone or together with progestin during 5 years before their diagnoses than it was in those who never had used HRT.

With regard to lobular breast cancer, recent use of any HRT for more than or equal to 57 months more than tripled the risk, and current use of combination therapy almost quadrupled risk. For nonlobular (primary ductal) cancer, recent HRT use for more than or equal to 57 months increased risk by 50% compared with no use. Findings for HRT use during 10 years before diagnoses were similar to the 5 year findings.

The report comments that the data are consistent with results from previous case controlled studies and indicate that HRT may pose greater risk for lobular cancer than for non-lobular cancer. Lobular cancer is less common than ductal cancer, but it may be more difficult to diagnose by palpation and mammography. It is important to remember, however, that only 20% of users take estrogen for more than 3 years and that users generally are women in their early 50s who seek relief from menopausal symptoms.

This report brings up interesting questions. It concludes that those most at risk are people who take HRT for longer periods of time. The group of women doing this are those who take HRT to help prevent osteoporosis as apposed to the more acute symptoms of menopausal symptoms. However, quite a number of women also continue to take HRT to help maintain youthful features and body and therefore, according to the study, are more likely to be at risk. In previous articles Ive written on this subject, evidence even questions the effectiveness of HRT as a treatment for osteoporosis as bone levels decline rapidly when the HRT is discontinued, even after many years of taking the treatment.

This report adds yet more weight to the argument that HRT therapy should only be done with great caution and should not be an automatic first step when approaching menopause or even when bone density levels show some decline in middle aged women.