HRT and breast cancer: Should I stop hormone replacement therapy after The Lancet report?

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On Thursday morning, I received a phone call from a guy at the BBC wanting to chat about the new study into hormone replacement therapy (HRT).

If you’ve missed the headlines, a new study in The Lancet says the risk of developing breast cancer from using HRT is higher than previously thought.

Standby – here’s the science. Bear with me…

Researchers at the University of Oxford, funded by Cancer Research UK and the Medical Research Council, looked at 58 studies dating from 1992-2018.

They concluded that HRT (except topical vaginal oestrogens) was responsible for 1 million deaths worldwide since 1990 and that the risk of developing breast cancer continued for up to ten years after stopping use.

They added that the risk was also higher for those women taking oestrogen and progesterone than it was for women only on oestrogen (used by women who have had a hysterectomy).

In addition, the risk was twice as great for women on HRT for 10 years, but there was little excess risk for women who only take HRT for a year.

Are you still with me? Because I switched off halfway through writing.

As I said to Shelagh Fogarty on LBC on Friday (yeah, I’m name-dropping!), I failed my Maths O-level five times (I got an X in one) and figures like this mean nothing to me.

It is heart-breaking if 1 million women died from breast cancer because they used HRT, but I need a context to know if that’s high or not. Is this higher or lower than, for example, breast cancer deaths from taking the contraception pill or drinking a bottle of wine each night?

So when the BBC guy phoned up saying the risk was “double what they previously thought”, yes, I did a double-take. Because that’s scary, right?

Well, yes, because that’s the headline. And as a professional headline-writer for more than 25 years, that’s exactly what I would write. Headlines are there to grab your attention. They take the piece of news that will draw you in to read the article and then set it in context in the story.

The trouble is that when you have a whole list of figures and facts like this, there is no context for women to compare risks.* Nor is there any historical context – what exactly did we think before? Is this really new?

Which is why Friday, after the story broke, was filled with a variety of experts giving their take on whether or not women should be concerned. By Saturday night, everyone seemed to be using the report as a way of pushing their own agenda, whether that was promoting herbal remedies or HRT clinics.

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It summed up everything that is wrong with how we treat menopause in the UK – the lack of a centralised approach to give women the information they need to make a considered response.

Instead, we have to run the gamut of everyone’s opinions and ideologies to try and find our own answers. Even some GPs advise us based on their beliefs rather than following NICE guidelines.

I may joke about my lack of Maths qualifications, but I’m an intelligent woman. I just missed out on a First at university (which I attended while also working full-time) and can hold my own when it comes to discussing topics of the day.

But HRT and whether or not to take it makes my head spin. I’m not a medical person – like the majority of us – so I need my experts to break the language down so I can understand it. And that means putting risks into context, not just shouting figures at us.

Which is why, far from giving women better information, The Lancet report has just muddied the waters more.

HRT and breast cancer is something I think about a lot. My sister had breast cancer in her 40s and my worries about any risk were one of the reasons I went on BBC Health: Truth or Scare.

On Thursday, nine hours after the BBC guy rang, I changed my HRT patch and stuck a new one on. I’m due to change it again on Monday and will. I have no intention of stopping for at least a year.

I’ve never been one to think about using HRT long-term and am looking at other coping mechanisms – in large part thanks to my Pausitivity co-founder Clare Shepherd, who gives considered advice about both HRT and other therapies rather than banging her drum for only one.

I am changing my diet, exercising more and meditating most nights to help my menopause insomnia (and yes, by keeping a diary I know that drinking disrupts my sleep a lot, but some things are harder to give up).

I’ve considered the risks as much as I can, but my horrendous menopause symptoms are still fresh in my mind and HRT is the only thing that has given me relief. From what I’ve read, the benefits outweigh the risk – although I wish I could say that with 100% certainty.

I know this isn’t a black or white issue and that everyone is different. That’s why it would be great if I could sit down with an expert and discuss my medical history in-depth, rather than being asked a few standard questions. Then I could be given recommendations based on my personal situation and feel assured.

There are a couple of simple ways that the medical world could help cut down the risk and give women confidence, too. GPs or practice nurses could perform a breast exam when we go in to discuss HRT and on follow-up appointments. They could also, on first giving a woman HRT, show us how to check our breasts properly. If it wasn’t for Google, I would have no idea. (You can find out how to examine your breasts in my piece about Coppafeel breast cancer charity.)

But sadly, simple ideas like this – or having a poster on display at your local GP surgery to help women know menopause symptoms or having GPs trained in menopause so they understand a condition that will hit 51% of the population – don’t seem to occur to the MEN in charge. I wonder why…

And while we have such little help, we have to look after ourselves. Do not be passive about your health. We each deserve to have the best life possible, but we have to play a part in that and be responsible for making sure we are the best we can be. Eat healthily, drink wisely and move every day.

And get to know your boobs.

HAS THE LANCET’S REPORT CHANGED YOUR MIND ABOUT TAKING HRT? I’D LOVE TO HEAR YOUR THOUGHTS. LEAVE ME A COMMENT BELOW.

(*I resisted a long rant about how this shows the need for sub-editors who can take the work of a health reporter – who have been studying the story and know it inside out and think everyone else does – and turn it into plain English so everyone understands it. Sadly, sub-editors are deemed redundant by many bean counters and are fast becoming a distant memory in many publications, which is why the quality of news reporting has fallen. A sub-editor is the person who says, on behalf of the reader: “But what does this mean, exactly?” and changes the copy accordingly. The lack of them shows more each day. But as I said, I resisted a rant…)

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