Hormone replacement therapy and breast disease

Abstract

Key content It is the addition of a progestogen that confers the increased risk of breast cancer diagnosis associated with HRT. Risk may be reduced by the use of combined regimens containing progesterone‐derived progestogen or dydrogesterone. The levonorgestrel‐releasing intrauterine system may be associated with an increased risk of breast cancer diagnosis. HRT may reduce the sensitivity and specificity of mammography but there is no direct clinical evidence that this reduces the small mortality benefit derived from the NHS Breast Screening Programme. Although breast cancer diagnosis may be increased with HRT, there is no robust evidence for an adverse effect on breast cancer survival. Learning objectives To understand the limitations of existing evidence. To acknowledge that uncertainty remains. Ethical issues Is it ethical to publicise risk factor data in terms of risk ratios and percentage changes? In the case of an uncertain intervention such as HRT for symptom alleviation, how can risk be balanced against benefit among women at high risk of breast cancer or breast cancer recurrence? Please cite this article as: Marsden J. Hormone replacement therapy and breast disease. The Obstetrician & Gynaecologist 2010;12:155–163.