Putting hormone replacement therapy risks into context, and living with dystonia

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What is the main topic discussed in this episode?

James Bullen 0:00

Hello and welcome to the Health Report with me, James Bullen. I'll be standing in for Norman Swann, who's away for the next three weeks. Today, a debilitating and at times misunderstood movement disorder.

Paul 0:11

There were times when I couldn't sleep because I'd be lying down and my head would be turning into the pillow. It'd be just forcing its way to the right into the pillow and I mean I was absolutely destroyed by it. And it's um the darkest period in my life.

James Bullen 0:28

But first, women using hormone replacement therapy, or HRT, to reduce menopause symptoms face an increased risk of developing breast cancer, and that risk can last more than a decade after the treatment stops. A major international review published last month in The Lancet has confirmed that link, and that the risk is greater with combined estrogen progestogen therapy than estrogen only therapy. The study combined data from more than 100,000 women. Women with breast cancer from 58 studies worldwide. A few of the headlines around this story were a little bit frightening, and indeed, some research in the early 2000s linking combination HRT with breast cancer saw rates of therapy use in Australia HAV.

James Bullen 1:07

That study was later found to be misleading, and HRT use has since stabilized to about 300,000 women. To unpack these latest findings in their context, ABC Health Reporter Olivia Willis joins me now. Liv, welcome back to the Health Report.

Olivia Willis 1:20

Thanks, James.

James Bullen 1:21

This connection between hormone replacement therapy and breast cancer isn't new. What's this review telling us that we didn't already know?

Olivia Willis 1:28

Yeah, that's right. So this relationship between HRT, or sometimes known as menopausal hormone therapy, and breast cancer, is fairly well established. But the researchers in this particular study were interested in looking at two kind of unanswered questions that we still had. So the first one being Are there breast cancer risks related to less than five years' use of HRT? And do breast cancer risks persist after the use of HRT stops? So on the First question they found, and this was new, they found that the answer is actually yes, which is kind of goes against, I guess, commonly accepted knowledge or wisdom around this, which is that up to five years previously was thought to be pretty safe. They found that there is a slightly increased risk for women using HRT for one to four years.

Olivia Willis 2:12

That risk is still relatively small, so it's about one extra case of breast cancer for every 70 years. users of the combination treatment and about one extra case for every 200 users of estrogen only therapy. On the positive side, there's very little, virtually no risk for women using HRT for less than one year or from the topical use of vaginally administered estrogens.

What are the new findings on hormone replacement therapy and breast cancer risk?

James Bullen 2:36

Right. And so what if you stop treatment? Do the risks continue then?

Olivia Willis 2:39

Yeah, interestingly they found that they the risk related to H so HRT related breast cancer risk, that gradually decreases after women stop using hormone therapies. But there is some increased risk that can persist for more than a decade, actually, they found after use stop. So the size of that risk post treatment really depends on how long the treatment was used for. Um and I guess that really aligns with what we already know, which is The longer women use HRT, the higher the risk they are in terms of breast cancer. But I should say that you know it's important to weigh up these risk factors in the context of other breast cancer risk factors. So we know things like age, weight, alcohol intake, family history, those are all really important.

Olivia Willis 3:21

And we also need to think about this in the context of the need for treatment and symptom symptom relief. So we know you know a lot of women start using hormone treatment. treatments around the time of menopause to manage symptoms like hot flushes, night sweats, vaginal dryness, all of which can have a really, you know, significant impact on quality of life. And so that also needs to be taken into account.

James Bullen 3:42

Right. And when you look at the absolute increase in risk, what does that boil down to?