Role of HRT in Women with a Family History of Breast Cancer
March 1, 1998
Role of HRT in Women with a Family History of Breast Cancer
It remains unclear about whether individuals with a family history of breast cancer should be advised to use hormone replacement therapy (HRT). After extensive and repeated meta-analyses, results continue to conflict about whether HRT and risk for breast cancer are related in the general female population. Since HRT also affects overall mortality, even if there is an increased risk of breast cancer, if reduction in total mortality in this same population is greater than the increased risk of breast cancer, clinicians will have to weigh both factors in their decision process.
The Iowa Women's Health Study consists of 41,837 women who were between the ages of 55 and 69 in 1985. The study was developed to examine the relationship between body fat and subsequent cancer and total mortality. Between 1985 and 1992, three follow-up questionnaires were completed by study participants.
Almost 1100 cases of postmenopausal breast cancer occurred during the study. Traditionally described risk factors (e.g., early age at menarche, high body mass index, alcohol intake) were, as anticipated, found to correlate with likelihood of breast cancer. Among women without a family history of breast cancer, HRT was not associated with a significantly greater risk of breast cancer. Among women with a family history of breast cancer, not only was there no statistically significantly increased risk of breast cancer when HRT users were compared with never-users, there was a 0.67 relative risk for total mortality, including total cancer-related mortality. Although each case merits an individual decision process, these data demonstrate a lower risk of death, even among persons with a family history of breast cancer.
Sellers T, et al. Ann Intern Med 1997; 127:973-980.
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