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For women on HRT, tenderness may be warning sign

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For women on HRT, tenderness may be warning sign

Women whose breasts became tender after taking hormone replacement therapy had nearly twice the risk of developing breast cancer than women whose breasts did not become tender on the drugs, U.S. researchers said on Monday.

They said breast tenderness may be a way to identify women who have a higher risk of developing breast cancer while taking hormone replacement therapy to treat menopause.

“We report that an increase in breast tenderness, easily detected by physicians or patients, identifies a population at particular risk for breast cancer,” Dr. Carolyn Crandall of the University of California Los Angeles and colleagues reported in the Archives of Internal Medicine.

The team analyzed data on the more than 16,000 women who took estrogen-plus-progestin as part of the widely publicized Women’s Health Initiative or WHI study, which was halted in 2002 when researchers found healthy menopausal women who took the drugs were more likely to develop breast cancer.

Most of the women in the WHI studies took Premarin or Prempro made by Wyeth.

Doctors now recommend hormone replacement therapy for women suffering severe menopause symptoms, but caution that they should use the lowest dose possible for the shortest period of time.

Crandall and colleagues culled through the data to see if breast tenderness played a role in breast cancer risk. In the study, 8,506 took estrogen plus progestin and 8,102 got placebo pills.

The women had mammograms and breast exams at the start of the trial and every year after that. They reported whether they had breast tenderness at the beginning of the trial and a year later.

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Breast defence

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Breast defence

Some women have specific genetic problems but those breast cancers number less than 10% of all. One expert recently told me that breast cancer causes are “multifactorial” and that the combination of lifestyle factors and genetic vulnerabilities that accounts for the abnormal growth of cells is still being figured out.

That means that most of the 22,700 Canadian women (and 180 men) expected to be diagnosed this year won’t even know what caused their illness. Neither will the 5,400 women who die from it. Sometimes we forget just how many different factors may contribute to breast cancer’s development. Here’s what’s known:

ESTROGEN

The more estrogen a woman makes over time or takes through post-menopausal combined hormone replacement therapy, the higher her risk for getting breast cancer. The more years a woman menstruates, the longer breast tissue is estrogen-exposed. Birth control pills only slightly increase risk.

AGE

The chance of getting breast cancer increases as a woman ages. According to Dr. Love, from 20 to 30 the risk is one in 2,000; from 40 to 49 the risk is one in 68; from 60 to 69 the risk is one in 26. After the age of 70, a woman has a one-in-eight chance of getting breast cancer.

ALCOHOL

The risk of breast cancer jumped by 30% in women who drank more than three drinks daily.

FAMILY HISTORY

Having a mother, sister or daughter with breast cancer almost doubles a woman’s risk, particularly if the relative was diagnosed before age 50. A family history of ovarian cancer also increases the risk of developing breast cancer.

RADIATION

Radiation therapy for a previous cancer heightens the risk of breast cancer. The risk is highest if there was chest radiation during puberty.

OBESITY

Post-menopausal women who are obese are more at risk; fat cells play a role in estrogen production so being overweight adds to risky estrogen exposure.

GENETIC MUTATIONS

Those who have inherited changes in the BRCA1 and BRCA2 genes have a higher risk (some up to 90%) of getting the disease, and possibly at a younger age. Many other genes are also associated with breast cancer, including the HER-2/neu oncogene.

ENVIRONMENT

We’re exposed to vast amounts of hormone-mimicking and cell-interrupting chemicals in products we use and through environmental pollutants, some of which increases the risk of breast cancer.

BREAST DENSITY

Dense breast tissue, as shown on a mammogram, increases your risk. One study published in the Journal of the National Cancer Institute found that the relative risk of developing breast cancer in post-menopausal women with dense breasts was 400% higher than in women with fatty non-dense breasts.

BREAST DISEASE

Some diseases, including hyperplasia, can increase breast cancer risk by up to four-fold.

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