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Physician Resource

UVA Health Research Settles the Hormone Therapy & Cancer Risk Question

Hormone therapy can be life-changing for women suffering hot flashes, disrupted sleep, and sexual problems during menopause. But long-standing questions about whether progestogens and estrogen increase the risk of breast cancer have plagued physicians.   

Now new research from UVA Health puts those questions to rest. Their new review in the scientific journal Menopause, along with other recent studies, gives much-needed clarity, say UVA Health’s JoAnn V. Pinkerton, MD, and Carolyn S. Wilson, MD.

Their research shows:

  • No higher risk of mortality from breast cancer for women taking HT
  • A HT combination can reduce risk to potentially zero

The Hormone Therapy & Cancer Risk Question

Conflicting results from previous large observational studies and two large randomized Women’s Health Initiative clinical trials muddied the waters for physicians.

This prompted Pinkerton and Wilson to search for a definitive answer by reviewing the differences between the trial data and the observational data.

No Link to Higher Mortality

Pinkerton and Wilson say their results “make a strong case” that hormone therapy does not increase the risk of invasive breast cancer for those who have had a hysterectomy. 

Estrogen combined with progesterone does increase the risk in patients who have not had a hysterectomy, especially when taken long-term. But that does not translate to a higher risk of death, they point out.

“The lack of higher mortality with combined estrogen and progesterone therapy is reassuring for those with a uterus who have been concerned about using hormone therapy at menopause,” Wilson notes. 

They also found that not all progestogens carry an equal risk. Estrogen combined with micronized progesterone and dydrogesterone does not increase breast cancer risk to the same degree as other combinations, if at all.

Important Insights for Physicians & Patients

Pinkerton and Wilson urge physicians to talk about the risks and benefits of hormone therapy with their patients. They recommend periodically reviewing whether to continue treatment while continuing breast cancer screenings. 

“Let’s replace fear with knowledge,” Pinkerton says. “Most healthy women under age 60 or within 10 years of having their last period who are having bothersome symptoms can take hormone therapy without fear at menopause if taking estrogen alone or combined with progesterone.” 

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