Menopausal hormone therapy and the risk of breast cancer
- Wendy Y Chen, MD, MPH
Wendy Y Chen, MD, MPH
- Assistant Professor of Medicine
- Harvard Medical School
- Section Editors
- Robert L Barbieri, MD
Robert L Barbieri, MD
- Editor-in-Chief — Obstetrics, Gynecology and Women's Health
- Section Editor — General Gynecology and Female Reproductive Endocrinology
- Kate Macy Ladd Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- William F Crowley, Jr, MD
William F Crowley, Jr, MD
- Section Editor — Female Reproductive Endocrinology
- Daniel K Podolsky Professor of Medicine
- Harvard Medical School
- Joann G Elmore, MD, MPH
Joann G Elmore, MD, MPH
- Editor-in-Chief — Primary Care (Adult)
- Section Editor — General Medicine
- Professor of Medicine, Adjunct Professor of Epidemiology
- University of Washington School of Medicine
One of the greatest concerns of women who are considering menopausal hormone therapy (MHT) is the relationship between hormone use and breast cancer. The results of the Women's Health Initiative (WHI) trial of combined estrogen-progestin, a large randomized, controlled trial, are consistent with the increased risk of breast cancer seen in many observational studies of MHT. (See 'Women's Health Initiative' below.)
Observational studies of MHT and breast cancer and the results from the WHI will be reviewed here. The relationship between endogenous hormones and breast cancer and a general discussion of the risks and benefits of MHT are discussed separately. (See "Factors that modify breast cancer risk in women" and "Menopausal hormone therapy: Benefits and risks".)
Support for the association of menopausal hormone therapy (MHT) with breast cancer is derived from studies that suggest that prolonged exposure to higher concentrations of endogenous estrogen increases the risk of breast cancer. These risk factors include:
●Reproductive factors, including age at menarche, age at first live birth, age at menopause, and possibly parity and breast feeding.
●Higher serum estrogen concentrations in postmenopausal women. The association is less clear in premenopausal women.
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- ENDOGENOUS HORMONES
- EXOGENOUS HORMONE THERAPY
- Epidemiologic data
- Women's Health Initiative
- - Combination therapy
- Absolute risk
- Post-WHI rates
- - Unopposed estrogen
- - Mammographic density
- - Abnormal mammography
- Duration of use
- Effect of progestins
- - Type of progestin
- - Mortality
- Timing of hormone therapy
- OTHER ISSUES
- Women with a family history of cancer
- Effect of testosterone
- Effect of alcohol
- Women with premature ovarian failure
- Effect of race on risk
- Personal history of breast cancer
- - Observational data
- - Clinical trial data
- INFORMATION FOR PATIENTS