Start HRT later to lower breast cancer risk

Delaying the use of hormone replacement therapy (HRT) for at least five years after menopause appears to protect women from breast cancer.

Data from a prospective study of more than one million postmenopausal women in the United Kingdom showed an increased incidence of breast cancer in current HRT users. That risk did return to the levels seen in never-users a few years after discontinuation of therapy. But the relative risks for breast cancer were 1.43 for current users of estrogen-only preparations who began treatment before or less than five years after menopause, and 1.53 for estrogen-progestin users, compared with the women who delayed treatment.

“A new finding of this study, which has been little investigated previously, is that the interval between menopause and starting hormonal therapy has a substantial effect on breast cancer risk,” the researchers wrote in the Journal of the National Cancer Institute.

This pattern of risk was seen across different types of hormonal therapy, among women who used hormonal therapy for either short or long durations, and in lean, overweight, and obese women.

In another recent study, menopausal women were able to stave off hot flushes and avoid HRT by using the antidepressant escitalopram (Lexapro). Healthy women taking 10-20 mg/day of the drug had fewer and less severe menopausal hot flushes than a placebo group at eight weeks’ follow-up (JAMA. 2011;305:267-274).

From the March 01, 2011 Issue of Clinical Advisor