Hawar, two long-known protective factors – early childbirth (in their teens and 20s) and prolonged breastfeeding – are at the forefront in the life goals of many modern women seeking graduate degrees and professional advancement, such as young women financially unable to raise a family.
Many older women run into another confusing and controversial decision: whether and how long to take hormone therapy to counteract life-threatening symptoms of menopause. By eliminating a previous history of breast cancer, current advice for women who have not had a hysterectomy is to take combination hormone therapy (that is, estrogen and a progestin) for as short a time as necessary to control symptoms, but no longer than a few years.
A recent study, published July 28 in JAMA, described the long-term effects on breast cancer risk among 27,347 women taking postmenopausal randomly assigned hormone replacement or not. The authors, led by Drs. Rowan T. Chlebowski at UCLA Medical Center, has been assessing the health status of participating women for more than two decades.
Among the 10,739 women who did not have a uterus and could safely take only estrogen (progestin is typically added to prevent uterine cancer), menopausal hormone therapy significantly reduced their risk of developing and dying from breast cancer. However, among the 16,608 women with a uterus who took the combination hormone therapy, the incidence of breast cancer was significantly higher, although there was no increased risk of dying from the disease.
In commenting on these results, Drs. Christina A. Minami, a breast cancer surgeon at Brigham and Women’s Hospital, and Dr. Rachel A. Freedman, an oncologist at Dana-Farber Cancer Center, said the new findings “probably will not lead to the use of hormone therapy for the sole purpose of reducing breast cancer risk.”
Mar Dr. Freedman said in an interview, “If I advise a patient who is really miserable with menopausal symptoms and is a candidate for estrogen alone, these findings are reassuring that their risk of breast cancer will not be higher in time.”
Then there is the possibility of taking a daily medication to suppress a potential breast cancer in women at high risk who do not yet have the disease. Dr. Jeffrey A. Tice, an intern at the University of California, San Francisco, suggested that gynecologists use one of several risk assessment calculators to determine how likely a patient may be to develop breast cancer. next five or 10 years.
