HRT and cancer risk: separating fact from fiction

Introduction and methods: The benefits of hormone replacement therapy (HRT) in postmenopausal women are well known including control of vasomotor symp toms and long-term benefits on the cardiovascular, skeletal and central ner vous systems. However, some studies have reported a link between long-term HRT use and cancer. This paper reviews some of the data related to HRT and major gynaecological cancers. Results: Appropriate HRT regimens can reduce the risk of endometrial hyperplasia in non-hysterectomised women and can re duce the incidence of colorectal cancer. There is no consensus on a link be tween HRT and ovarian cancer, and the data relating to HRT and breast cance r presents differing risk analyses. However, it is generally accepted that HRT taken for 5 years or less does not increase the risk of breast cancer. When HRT is taken for 10 years or more, the relative risk of being diagnose d with breast cancer is 1.46. Individual risk must be weighed against the b enefits offered by HRT, especially in terms of the long-term beneficial eff ects on the cardiovascular, skeletal and central nervous systems. Whilst on e in 8-12 women may contract breast cancer in the western world, one in 3 w omen over 65 will have cardiovascular disease and 30-50% of postmenopausal women will have osteoporosis. Conclusion: Fear of cancer is one of the main reasons why women object to HRT. Physicians must be able to counteract thi s fear with fact, and counsel patients on their individual risk, as well as putting any cancer risk into perspective with other long-term benefits. (C ) 1999 Elsevier Science Ireland Ltd. All rights reserved.