HRT ‘Raises Risk of Ovarian Cancer By 20 Per Cent’
By Lyndsay Moss
WOMEN who take hormone replacement therapy are at substantially increased risk of dying of ovarian cancer, according to a shocking new report.
The study of almost a million women found that HRT increases the risk of getting ovarian cancer by 20 per cent.
Researchers believe the therapy is responsible for 1,000 deaths between 1991 and 2005.
Millions of women across the world still take HRT to reduce unwanted symptoms of the menopause, such as hot flushes, night sweats, mood swings and depression.
The new report is the latest in a series of findings linking HRT to increased risk of cancer, heart attacks and strokes, which have seen the number of prescriptions issued halve from two million a year to one million.
The scientists behind yesterday’s study said that it “clearly demonstrated” the cancer risks of taking HRT. Women concerned by the findings were urged to contact their GPs.
However, health campaigners criticised the research for frightening women unnecessarily.
The latest findings, from a “Million Women Study” and published in the Lancet, focused on 948,576 post-menopausal UK women, representing a quarter of women aged 50 to 64.
About a third of the women were undergoing HRT, while a further fifth had received treatment in the past. All were monitored for up to seven years.
During this time, 2,273 women developed ovarian cancer and 1,591 died.
From this, the researchers, funded by Cancer Research UK, calculated that for every 1,000 women taking HRT, 2.6 developed ovarian cancer over five years – compared with 2.2 per 1,000 in women who did not use HRT.
They estimated that HRT use was likely to have resulted in an extra 1,300 cases of ovarian cancer and 1,000 deaths from the disease between 1991 and 2005.
About 7,000 women are diagnosed with ovarian cancer each year. The study found the risk of ovarian cancer increased by 20 per cent among HRT users, but was higher still when taking into account other cancers.
The Million Women Study – the largest of its kind in the world – has already linked HRT with a greater risk of breast and endometrial cancer – cancer of the lining of the womb.
The three diseases account for almost 40 per cent of all cancers in women in the UK and 25 per cent of deaths. “The effect of HRT on ovarian cancer should not be viewed in isolation, especially since use of HRT also affects the risk of breast and endometrial cancer,” the researchers said.
“The total incidence of these three cancers in the study population is 63 per cent higher in current users of HRT than ‘never users’.
“Thus, when ovarian, endometrial and breast cancer are taken together, use of HRT results in a material increase in these common cancers.”
The risk of cancer is thought to increase the longer HRT is used, leading experts to recommend that it is used for as short a time as possible.
The study found that the risk of ovarian cancer increased regardless of which kind of HRT women were using – oestrogen-only or oestrogen and progestogen. But it also found that women’s risk of ovarian cancer returns to normal a few years after stopping use of HRT.
The lead researcher, Professor Valerie Beral, of the University of Oxford, said: “The results of this study are worrying, because they show that not only does HRT increase the risk of getting ovarian cancer, it also increases a woman’s risk of dying of ovarian cancer. This study, along with our previous research, clearly demonstrates the cancer risks of taking HRT.”
Professor John Toy, medical director of Cancer Research UK, said: “This study clearly shows that taking HRT increases a woman’s chance of getting ovarian cancer and her chances of dying from the disease.
“Considering this alongside the increases in risk for breast and endometrial cancer, women should think very carefully about whether to take HRT.
“And women who choose to take HRT should aim to do so for clear medical need and for the shortest possible time.”
But Dr John Stevenson, of Women’s Health Concern, accused the researchers of frightening women and overstating the risks of HRT. “It is showing a very small increased risk,” he said. “They have done a study over a few years, but have extrapolated the figure over 14 years to make it sound important. This is just substituting science with sensationalism.”
Ovarian Cancer Action said it was concerned about the link between HRT and cancer. But the group said it appeared that less than 2 per cent of all ovarian cancers could be attributed to HRT.
Annwen Jones, the charity’s chief executive, added: “Given the overall increased risk of developing breast, endometrial or ovarian cancer, Ovarian Cancer Action suggests that women concerned should discuss these results with their doctor.
“In particular, it is important that women neither stop nor start taking HRT without seeking medical advice.”
Professor Sean Kehoe, spokesman for the charity Wellbeing of Women, said the increased risk of cancer needed to be balanced against the potential effects on quality of life when ceasing HRT. “If a woman does not want to carry this extra risk, then of course, from the information presently available, stopping HRT seemingly reduces this.”
LONG-TERM DEBATE
THE menopause and HRT treatment first became a subject of intense interest to the medical profession in the 1960s.
Demand for the treatment was helped by Dr Robert Wilson, a New York-based gynaecologist who wrote an international bestseller, Feminine Forever. It praised estrogen replacement, which he said would save women from the “tragedy of menopause, which often destroys her character as well as her health”.
Many women’s magazines promoted the idea that estrogen was a type of “youth pill” capable of transforming the lives of middle-aged women and delaying the ageing process.
Pharmaceutical companies launched aggressive promotions and advertising campaigns.
However, in the early 1970s the use of estrogen was questioned, with fears that it could increase the rates of endometrial cancer and shorten the lifespan of users.
New approaches were sought with the emphasis moving away from preserving youth to promoting health benefits.
‘I TRIED TO COME OFF IT’
CAROL Morton, pictured, knows what it feels like to live with ovarian cancer.
Since she was diagnosed in 1999, the cancer has come back twice. During this time the 59-year-old from Nairn has also had to decide whether she should continue taking hormone replacement therapy (HRT) as more and more research has linked it to a higher risk of cancer.
Ms Morton said that if the research now published had been available when she was first offered HRT, she would have thought twice about using it.
“When concerns were first raised about HRT and cancer, I tried to come off it a couple of times,” she said. “But the menopausal symptoms were so bad and it affected my quality of life so much that I went back on it.”
But as more research emerged, Ms Morton said:
“I got twitchy about it and thought I should stop as I had been on it for quite a long time.
I have been off HRT for about two years.”
Q & A: WHAT DOES THE RESEARCH MEAN FOR YOU?
What is hormone replacement therapy (HRT)?
HRT is the artificial replacement of the female hormone oestrogen in women who are going through the menopause. Symptoms of the menopause include hot flushes, night sweats, mood swings and depression. HRT can reduce these symptoms.
What types are available?
Most women take a combination of oestrogen and progestogen. The progestogen is added to protect against womb cancer. Oestrogen alone may be prescribed to women who have had a hysterectomy. It can be taken in a variety of forms, including patches, gels, creams and implants.
How long do women need to take HRT for?
This will vary from person to person. The advice to GPs is to review medication on an annual basis. Experts advise that the treatment is not used for longer than five years.
What concerns have been raised about HRT?
Since 2002, research has raised concerns that HRT may be linked to serious side-effects. A study in the United States found it increased the risk of heart attack and strokes. In 2003, the Million Women Study showed a link between HRT and breast cancer, followed by a link with endometrial cancer – cancer of the lining of the womb.
Is research on HRT all bad?
No. Earlier this month a study published in the Journal of the American Medical Association said HRT actually reduced the risk of heart attacks in women in their fifties and the increased risk was only in older women. Others have suggested the risks identified in the studies are small compared with the overall benefits of using HRT.
What does the latest study show?
The latest findings suggest that between 1991 and 2005, an extra 1,300 cases and 1,000 deaths from ovarian cancer were linked to HRT use. During this period, 105,000 women in the UK will have been diagnosed with the disease.
What should women taking HRT do if they are concerned about this research?
Women worried about their medication should make a non-urgent appointment with their GP to discuss the situation. Doctors say as long as women are having their medication reviewed regularly, they should not worry.
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