Why Choose Hormones If They Cause Breast Cancer? Read this whole article!

If you’ve heard that taking hormones will cause breast cancer, you’re not alone.

If you’ve heard mixed information, some people saying they do cause breast cancer and some people saying they don’t cause breast cancer, you’re also not alone.

All this does is confuse us.

Allow me to clarify.

In a world of short videos and fast media, our attention span is about 8 seconds.  That doesn’t leave time to discuss nuances of medical studies or individual treatments.  The video got your attention though, didn’t it?  That’s the goal of social media.

The goal of medical care, in my opinion and practice, is highly nuanced and individualized.  You are different from every other person on this planet, and every single person can say that!  That means most things aren’t absolutes.  We want absolutes because it fits in an 8 second video (“Everyone should exercise in the morning!  Here’s why.”  Or “No one should be eating this anymore.  Here’s why.”). We’ve all seen the videos and headlines.  They are catchy, sometimes they are true, for some people.

This topic is one that needs explained in detail to fully understand it.  There are some absolutes which we will get to, but hormone therapy is otherwise very dependent on the individual patient.

Let’s start with why this is even a topic.

In 2002, a study called the WHI (Women’s Health Initiative) was published showing an increase in invasive breast cancer which led to a media frenzy and subsequent trashing of everyone’s hormones.  It scared women out of using their hormone therapy.

This study had three test groups.  It was a well-designed study which is important.

The three groups were:

1. Estrogen plus progesterone

2. Estrogen alone

3. Placebo

Here’s an absolute: anyone with a uterus should not be on estrogen alone.  Why?  Estrogen leads to growth of the uterine lining.  Without the balance of progesterone, overgrowth can lead to pre cancer or cancer cells.  This is why the groups were split this way.

The test group taking estrogen plus progesterone had an increase in invasive breast cancer and the trial was stopped early due to this.

This is where the media pounced.  Hormone use was cut in half after this was released.

BUT!  There’s more.

Here are the good things:

The estrogen alone group actually had a decrease in breast cancer risk.

Both estrogen alone and estrogen plus progesterone had decrease in hip fracture.

Estrogen plus progesterone also had a decrease in colon cancer.

Other risks were an increase in blood clotting (think heart attack, stroke).

BUT!  Let’s look deeper.

The majority of patients in the study were in their 60s.  People up to age 79 were included!  The smallest proportion of study patients were women in their 50s.

Was the increase in dangerous blood clotting partly due to age?

When the data was analyzed afterward, women in their 50s actually showed a decrease in all-cause mortality (that means dying from anything) and improved cardiovascular outcomes.

Age mattered, and when the hormone therapy began in menopause mattered.

This is why hormones can, and perhaps should, be prescribed to women less than age 60 or less than 10 years from their last period.

Here are some absolute reasons you cannot use hormones:

• You’ve personally had breast cancer before

• You’ve personally had another hormone-sensitive cancer before

• You have abnormal uterine bleeding or postmenopausal bleeding that has not been investigated yet

• You’ve had a heart attack, stroke, or blood clot in your leg or lungs

• You have liver disease or kidney disease

If you don’t have any of those, if you’re under age 60 or less than 10 years from your last period, you could be on hormone therapy.

Interestingly, a medication called bazedoxifene can be used instead of progesterone, with estrogen, to protect the uterus.  This has been shown to have a decreased risk of breast cancer, a positive effect on bone health.  The risk of this type of medication is an increased risk of blood clotting as we’ve discussed.

I don’t expect the public to remember these nuances.  The media certainly doesn’t expect that because it’s catchier to divide things into absolutes in less than 8 seconds.

Resources:

Some of the information contained in this article is the result of my training, medical knowledge, and personal experience without a specific source to be cited.

Menopause Practice, A Clinician’s Guide: 6th edition.  The North American Menopause Society.  (Now called The Menopause Society)

Midi health webinar, August 2024.