Management of women at high risk of breast cancerBMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g2756 (Published 28 April 2014) Cite this as: BMJ 2014;348:g2756
All rapid responses
Armstrong and Evans1 ignore the fact contraceptive and menopausal hormones have caused an epidemic of breast cancer which reduces if hormone use declines.2
More young women than ever before have a positive family history of young age breast cancer as most contraceptive use is started long before age 30.
Teenagers are being given long-acting progestogens and breast cancer risks increase with longer use.3-5 Among women starting OCs before age 18 and developing breast cancer by age 36, 80% had taken OCs for more than 4 years.5 Invasive breast cancer is increasing most in young women. From 1976 to 2009 invasive breast cancer doubled in incidence in women aged 20 to 34 years from 1.53 to 2.90 per 100,000/year. The US national 5-year survival for distant disease was 31% for women aged 25-39 years.6
In contrast, breast cancer incidences and mortality decreased In older women after hormone replacement therapy (HRT) was discredited in 2004.7,8 Progestogens caused more breast cancer than oestrogens In both the Million Women Study and the US Women's Health Initiative (WHI) studies progestogen HRT caused 4 times more breast cancer than oestrogen-only HRT.3 10 years of progesterone or oestrogen HRT increased risks 3 times more breast cancer than 5 years of use. 9,10
Why is there a reluctance to face these facts?
1 Armstrong AC. EvansGD. Management of women at high risk of breast cancer.BMJ 2014;348:g2756
2 Grant ECG. Re: Understanding recent trends in incidence of invasive breast cancer in Norway: age-period-cohort analysis based on registry data on mammography screening and hormone treatment use BMJ (Published 31 January 2012)
3 Grant ECG. Steroid and sexual abuse of adolescents BMJ (Published 14 January 2005)
4 Grant ECG. Re: Newer non-oral hormonal contraception BMJ (Published 11 March 2013
5 UK National Case-Control Study Group. Oral contraceptive use and breast cancer risk in young women. Lancet 1989 May 6;1(8645):973-82.
6 Johnson RH, Chein FL, Bleyer A. Incidence of breast cancer with distant involvement among women in the United States, 1976 to 2009. JAMA 2013;309(8):800-805
7 Grant ECG. Fall in HRT use would have reduced breast cancer mortality. BMJ (Published 28 January 2005)
8 Colditz GA. Decline in breast cancer incidence due to removal of promoter: combination estrogen plus progestin. Breast Cancer Res. 2007;9:108.
9 Beral V, Banks E, Reeves G, Bull D, on behalf of the Million Women Study Collaborators. Breast cancer and hormone-replacement therapy: the Million Women Study. Lancet 2003; 362: 1331.
10 Chlebowski RT, Hendrix SL, Langer RD, et al, for the WHI Investigators. Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women's Health Initiative randomised trial. JAMA 2003: 289: 3243-53.
Competing interests: No competing interests