Editorials

Hormone replacement therapy and the breast

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7326.1381 (Published 15 December 2001) Cite this as: BMJ 2001;323:1381

We should worry about the increase in the risk of breast cancer

  1. J M Dixon, consultant surgeon and senior lecturer (jmd@wght.demon.co.uk)
  1. Edinburgh Breast Unit, Western General Hospital, Edinburgh EH4 2XU

    Increasing numbers of women in their 50s and 60s are using hormone replacement therapy to alleviate menopausal symptoms. The effect of long term use of these agents in women aged over 50 on the breast is only now becoming apparent. Hormone replacement therapy given to perimenopausal women increases breast pain and nodularity, increases the frequency of benign cysts and fibroadenomas in the breast, and results in the growth of some already established benign lesions.1

    Breast density increases in 17% to 73% of women who use hormone replacement therapy depending on how breast density is assessed. No clear relation exists between duration of therapy and change in density on mammography. Combinations of oestrogen and progestogen increase breast density more than oestrogen alone. Continuous use of combined preparations of oestrogen and progestogen increase density more than their sequential use.2 Hormone replacement therapy affects both the sensitivity and specificity of breast screening. This is because the efficacy of breast screening depends on the decreasing breast density seen with age.

    In a recent study of 103 770 women from Australia …

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