Don’t just ditch that patch... the risk is still low

A link between breast cancer and HRT was established with the publication in 2001 of the Million Women Study, where 1,084,110 women in Britain aged 50 to 64 provided information about their use of the drugs and were followed up for cancer incidence.

The new data suggests that the risk is doubled, and even tripled for those on the HRT long-term.

But does this mean you should bin your pills or patches? Absolutely not. In real terms, the overall risk is still low and you will have been prescribed this treatment for a good reason. Here

are three questions that regularly crop up, and my responses:

Q: Women are being told to decide for themselves, but it’s so confusing. Why can’t someone just say whether or not HRT is safe? A: No medicine is 100% safe. The use and recommendations for drugs often evolve as we learn more, making it hard to give absolute answers. It is not clear why some women taking HRT will develop cancer and some won’t.

What we do know is that there are many risks for breast cancer such as alcohol consumption, family history, BMI, breastfeeding history and number of pregnancies. And all of this contributes to an individual’s chances.

It is also very important to take into account how an individual’s life is affected: menopausal symptoms can be debilitating and destructive to quality of life.

Q: I find myself going doolally every time I try to reduce my dose. Should I just suffer to save myself the risk of cancer?

A: This is an individual choice. A supportive GP should try to encourage women to identify which symptoms are the worst and can prescribe non-hormonal medicines to control, for example, hot flushes, or antidepressants for mood changes. The guidance continues to be that women should be on the lowest dose for the shortest length of time that is necessary. Q: I’m on the combined pill that was found to have the highest risk. Can I switch to the oestrogen-only option, which doesn’t carry that risk? A: We always prescribe a combined pill in women who have not undergone a hysterectomy. It is well established that oestrogen without progesterone is a significant risk factor for endometrial cancer.

Therefore the oestrogen-only option is only given to those women who have had a hysterectomy and therefore have no womb at risk. Changing to oestrogen-only would be swapping one cancer risk for another.