Does postmenopausal estrogen plus progestin therapy increase breast cancer risk?

It’s not rare for my female patients who are in menopause to ask whether postmenopausal estrogen plus progestin therapy increases breast cancer risk. We used to think that women could take estrogen plus progestin (Prempro, etc) for 5 years without increasing breast cancer risk. Then this was shortened to just 2 to 3 years … and now some experts say there is NO safe period.

New evidence also suggests that estrogen plus progestin increases the risk of ADVANCED breast cancer … and almost doubles MORTALITY.

But, and this is CRITICAL, this explains only the RELATIVE risk. The increase in ABSOLUTE risk is very small … about 1 or 2 more breast cancer deaths for every 10,000 women taking Prempro for one year.

In other words, the risk of breast cancer mortality does DOUBLE, but only from less than 1 per 10,000 to 1-2 per 10,000. So, the RELATIVE RISK almost doubles, but the ABSOLUTE RISK is very, very, very low.

The experts at the Prescribers Letter tell healthcare professionals, “Tell women on estrogen ALONE that this DOESN’T apply to them. Taking Premarin for about 7 years doesn’t increase breast cancer risk … but this is only appropriate for women without a uterus.”

Save hormone therapy for moderate to severe menopausal symptoms. Continue to use the lowest effective dose for the shortest duration.

For just vaginal symptoms, try vaginal lubricants, moisturizers, or vaginal estrogen therapy (Vagifem, Estring, etc).

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