Breast Cancer and HRT

Does Hormone Replacement Therapy increase the risk of breast cancer?  

Well ... Does hormone therapy increase the risk of breast cancer?

It doesn't seem so.

The belief that HRT increases the risk of breast cancer is without merit.  It is primarily based on misinformation communicated to the media and health professionals by a seemingly reliable source, the National Institutes of Health (NIH) sponsored Women’s Health Initiative (WHI).  The results of the WHI  Estrogen Plus Progestin (E Plus P) Trial was published in the July, 17, 2002 issue of the Journal of the American Medical Association (JAMA) The article stated that there was a substantial increase in the risk of breast cancer associated with the hormones used in the study.

It is clear that the writers group of the NIH-sponsored project misrepresented their study findings as the data collected in the study did not support this conclusion.   What their agenda was remains unknown.

If this is true why does my doctor tell me estrogen causes breast cancer?

Unfortunately, very few physicians actually bothered to read the WHI article and most received their information from the media or from colleagues who didn’t read it.  As a result how they advised and treated their patients was often sub optimal.  The WHI article including the conclusions and recommendations was written by twelve individuals, eight non-physicians and four physicians, known as The Writing Group for the Women’s Health Initiative Investigators.  Only two of the four physicians were practicing and none of them were known to have expertise in menopausal medicine.  Incredibly the conclusions of the writers group were accepted by most physicians and the media with a complete absence of professional skepticism.  Physicians who had prescribed HRT for years with good patient results without independent thought or analysis simply stopped writing prescriptions for HRT and told their patients they could no longer use it.

Dr. Jacque Rossouw, the physician who heads the WHI and was in charge of the study, did not believe the WHI study provided evidence that the hormones used in the study increased the risk of breast cancer.  He said the WHI E Plus P study lasted only a little over five years and that during that time a breast cancer initiated by the hormones could not have grown to a size large enough to have been detected by mammography or a physician examination.  Dr. Rossoux was clear in saying that the breast cancers discovered were there before the study began.   How would I know that Dr. Rossoux said this?  I have spoken to Dr. Rossoux several times, face to face and on the phone. He told me this directly and the wording he used was that the breast cancers pre-existed the study.  I would presume that if an investigative reporter took the time to call him at the NIH he would tell them the same thing.

Consider some comments from recognized authorities in menopausal medicine:

A recent article in the Journal of the International Menopause Society, Climacteric, The Journal of Adult Women’s Health and Medicine in June 2014 concluded:

“Over-interpretation and misrepresentation of the WHI findings have damaged the health and well-being of menopausal women by convincing them and their health professionals that the risks of HT outweigh the benefits.” 

An excerpt from an editorial published in a prior issue of the Climacteric, and was endorsed by seven members of the Board of the International Menopause Society concluded:

“On current assessment, the WHI trial the most important and the most ambitious project in menopause medicine, has done a great disservice to the well-being and health of adult women.”

In an issue in the Journal Menopause Management, James Simon, MD, clinical professor at George Washington University, President and Medical Director of Woman’s Health & Research Consultants, Washington, DC, and a Past president of the North American Menopause Society, wrote in a “Letter to the Editor:

“While I applaud those WHI investigators who are finally emerging to voice their concern and frustration with being excluded from the July 2002 media- grabbing media-distorting WHI publication, they now must find their own absolution and path to redemption.

An entire generation of women, their partners and their families suffer unnecessarily for their collective sins.”

Summary

The events that transpired following the WHI publication were and continue to be a tragedy for menopausal women.  The media did their job which is primarily to sell advertising by sensationalizing anything that is remotely possible to sensationalize. Physicians failed in their responsibility to their patients by responding to the WHI’s publication without independent thought or compassion for their patients. 

Dr. Jerry Nosanchuk is a practicing physician who has specialized in the care of menopausal women for over 30 years.  His office is located in Bingham Farms, Michigan.  Appointments with Dr. Nosanchuk can be made by calling: (248) 644-7200 and speaking to Caroline Monday through Friday from 10AM to 6PM

IMPORTANT: This website is for educational purposes only.  It is not intended to suggest a specific therapy for any individual and must not be construed to establish a physician patient relationship.