Menopauseal hormonal therapy and the risk of breast cancer in the light of new data

Literature review

Authors

  • O.О. Yefimenko SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”; State Scientific Institution “Center for Innovative Medical Technologies of the NAS of Ukraine”, Kyiv , Ukraine http://orcid.org/0000-0003-1228-0911

DOI:

https://doi.org/10.18370/2309-4117.2022.66.77-80

Keywords:

menopausal hormone therapy, estradiol, micronized progesterone, breast cancer risk

Abstract

Menopause is a natural and inevitable physiological process of the decline of reproductive function due to a decrease in ovarian function, which every woman has to face after about 45–60 years. During this period of hormonal changes the female body needs support more than ever, because the quality of life of a modern woman directly depends on it.
The question of the menopausal hormone therapy (MHT) safety in relation to the risk of breast cancer is a perennial subject of research, studied and debated in the medical literature for more than 20 years. During this time, several different studies on this issue were conducted.
In this review we describe previous insights along with recent research using estradiol and natural micronized progesterone in MHT regimens. The body
of evidence suggests that modifiable lifestyle factors (such as obesity and alcohol consumption) rather than combined MHT are the real breast cancer risks; combined MHT containing estradiol and micronized progesterone was not associated with an increased risk of breast cancer; when prescribing MHT, micronized progesterone may be a safer progestogen.
The clinical significance of the obtained results is also discussed.

Author Biography

O.О. Yefimenko, SI “O.M. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the NAMS of Ukraine”; State Scientific Institution “Center for Innovative Medical Technologies of the NAS of Ukraine”, Kyiv

PhD, senior researcher at the Endocrine Gynecology Department; 
Department of Reproductive Health 

References

  1. North American Menopause Society. “The 2022 hormone therapy position statement of The North American Menopause Society.” Menopause 29.7 (2022): 767–94.
  2. Nappi, R.E., Simoncini, T. “Menopause transition: a golden age to prevent cardiovascular disease.” Lancet Diabetes Endocrinol 9.3 (2021): 135–7.
  3. Newson Health Menopause Society. The Cancer Journal, May/June 2022: Special edition on hormone therapy and breast cancer. Available from: [https://www. nhmenopausesociety.org/research/the-cancer-journal-may- 2022-special-edition-on-hormones-and-breast-cancer/].
  4. Scheid, D., Coleman, M.T., Hamm, R.M. “Do Perceptions of Risk and Quality of Life Affect Use of Hormone Replacement Therapy by Postmenopausal Women?” J Am Board Family Pract 16.4 (2003): 270–7. DOI: 10.3122/jabfm.16.4.270
  5. Rossouw, J.E., Anderson, G.L., Prentice, R.L., et al. “Risk and benefits of estrogen plus progestin in health postmenopausal women: principal results from the WHI Randomized controlled trial.” JAMA 288.3 (2002): 321–3.
  6. Anderson, G.L., Limacher, M., Assaf, A.R., et al. “Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: The Women’s Health Initiative randomized controlled trial.” JAMA 291.14 (2004): 1701–12.
  7. Grossman, D. “Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Women US Preventive Services Task Force Recommendation Statement.” JAMA 318.22 (2017): 2224–33. DOI: 10.1001/jama.2017.18261
  8. Benjamin, E.J., Muntner, P., Alonso, A., et al. “Heart disease and stroke statistics – 2019 update: a report from the American Heart Association.” Circulation 139 (2019): e56–e528.
  9. Nichols, M., Townsend, N., Scarborough, P., Rayner, M. “Cardiovascular disease in Europe 2014: epidemiological update.” Eur Heart J 35.42 (2014): 2950–9. DOI: 10.1093/eurheartj/ehu299
  10. Fletcher, S.W., Elmore, J.G. “Clinical practice: Mammographic screening for breast cancer.” NEJM 348.17 (2003): 1672–80.
  11. Baber, R.J., Panay, N., Fenton, A.; IMS Writing Group. “2016 IMS Recommendations on women’s midlife health and menopause hormone therapy.” Climacteric 19.2 (2016): 109–50.
  12. Ortmann, O., Beckermann, M.J., Inwald, E.C., et al. “Peri- and postmenopause-diagnosis and interventions interdisciplinary S3 guideline of the Association of the scientific medical societies in Germany (AWMF 015/062): short version.” Arch Gynecol Obstet 302.3 (2020): 763–77.
  13. de Villiers, T.J., Hall, J.E., Pinkerton, J.V., et al. “Revised global consensus statement on menopausal hormone therapy.” Maturitas 91 (2016): 153–5.
  14. Tan, D.A, Dayu, A.R.B. “Menopausal hormone therapy: why we should no longer be afraid of the breast cancer risk.” Climacteric 25.4 (2022): 362–68. DOI: 10.1080/13697137.2022.2035711
  15. Neuhouser, M.L., Aragaki, A.K., Prentice, R.L., et al. “Overweight, obesity, and postmenopausal invasive breast cancer risk: A secondary analysis of the Women’s Health Initiative randomized clinical trials.” JAMA Oncology 1.5 (2015): 611–21.
  16. World Health Organization. Alcohol is one of the biggest risk factors for breast cancer. Available from: [https://www.who.int/europe/news/item/20- 10-2021-alcohol-is-one-of-the-biggest-risk-factors-forbreast- cancer#:~:text=Breast%20cancer%20is%20the%20 most,cancer%20cases%20in%20the%20Region.]
  17. Vinogradova, Y., Coupland, C., Hippisley-Cox, J. “Use of hormone replacement therapy and risk of breast cancer: nested case-control studies using the QResearch and CPRD databases.” BMJ 371 (2020): m3873. DOI: 10.1136/bmj.m3873
  18. Yang, Z., Hu, Y., Zhang, J., et al. “Estradiol therapy and breast cancer risk in perimenopausal and postmenopausal women: a systematic review and metaanalysis.” Gynecol Endocrinol 33.2 (2017): 87–92.
  19. Horwitz, K.B., Sartorius, C.A. “90 YEARS OF PROGESTERONE: Progesterone and progesterone receptors in breast cancer: past, present, future.” J Mol Endocrinol 65.1 (2020): T49–T63. DOI: 10.1530/JME-20-0104
  20. Stute, P., Wildt, L., Neulen, J. “The impact of micronized progesterone on breast cancer risk: a systematic review.” Climacteric 21.2 (2018): 111–22. DOI: 10.1080/13697137.2017.1421925
  21. Graham, S., Archer, D.F., Simon, J.A. “Review of menopausal hormone therapy with estradiol and progesterone versus other estrogens and progestins.” Gynecol Endocrinol (2022): 1–20.
  22. Fournier A., Berrino F., Clavel-Chapelon, F. “Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study.” Breast Cancer Res Treat 107.1 (2008): 103–11.
  23. Fournier, A., Fabre, A., Mesrine, S., et al. “Use of different postmenopausal hormone therapies and risk of histology- and hormone receptor-defined invasive breast cancer.” J Clin Oncol 26.8 (2008): 1260–8.
  24. Cobin, R.H., Goodman, N.F.; AACE Reproductive Endocrinology Scientific Committee. “American Association of Clinical Endocrinologists and American College of Endocrinology Position Statement on Menopause-2017 Update.” Endocr Pract 23.7 (2017): 869–80.
  25. Stevenson, J.C., Rozenberg, S., Maffei, S., et al. “Progestogens as a component of menopausal hormone therapy: the right molecule makes the difference.” Drugs in Context 9 (2020): 2020-10-1. DOI: 10.7573/dic.2020-10-1
  26. Liu, J.H., Black, D.R., Larkin, L., et al. “Breast effects of oral, combined 17β-estradiol, and progesterone capsules in menopausal women: a randomized controlled trial.” Menopause 27.12 (2020): 1388–95.
  27. Yang, Z., Hu, Y., Zhang, J., et al. “Estradiol therapy and breast cancer risk in perimenopausal and postmenopausal women: a systematic review and metaanalysis.” Gynecol Endocrinol 33.2 (2017): 87–92. DOI: 10.1080/09513590.2016.1248932
  28. Abenhaim, H.A., Suissa, S., Azoulay, L., et al. “Menopausal Hormone Therapy Formulation and Breast Cancer Risk.” Obstet Gynecol 139.6 (2022): 1103–10. DOI: 10.1097/AOG.0000000000004723
  29. Manson, J.E., Kaunitz, A.M. “Menopause management – Getting clinical care back on track.” N Engl J Med 374.9 (2016): 803–6.
  30. Chlebowski, R.T., Anderson, G.L., Aragaki, A.K., et al. “Association of Menopausal Hormone Therapy With Breast Cancer Incidence and Mortality During Long-term Follow-up of the Women’s Health Initiative Randomized Clinical Trials.” JAMA 324.4 (2020): 369–80. DOI: 10.1001/jama.2020.9482
  31. Eisen, A., Lubinski, J., Gronwald, J., et al. “Hereditary Breast Cancer Clinical Study Group. Hormone therapy and the risk of breast cancer in BRCA1 mutation carriers.” J Natl Cancer Inst 100.19 (2008): 1361–67. DOI: 10.1093/jnci/djn313
  32. Magraith, K., Stuckey, B. “Making choice at menopause.” AJGP 48.7 (2019): 457–62. DOI: 10.31128/AJGP-02-19-4851

Published

2022-08-10

How to Cite

Yefimenko, O. (2022). Menopauseal hormonal therapy and the risk of breast cancer in the light of new data: Literature review. REPRODUCTIVE ENDOCRINOLOGY, (66), 77–80. https://doi.org/10.18370/2309-4117.2022.66.77-80

Issue

Section

Management of menopause