How to manage a patient’s fear of breast cancer and taking MHT.

In the final session of Monday’s lunchtime symposium, Dr. Lydia Marie-Scemama took attendees through the best ways to manage patient’s fears of breast cancer.

Research shows that menopause is the period where breast cancer can peak, and this is one of the biggest concerns for women who are considering taking MHT.  The VIVA survey which was based on 3520 postmenopausal women from 7 countries in North America and Northern Europe showed that 53% of patients thought oral Hormone therapy would increase breast cancer risk. Patient’s understanding and expectations play a huge part in their treatment choices. In an international online survey completed by 1467 women, 47% of women reported that they felt unable to make an informed choice about hormone therapy, of the 55% of women who used an alternate non-hormone therapy, 39% of them admitted they did not know enough to make an informed choice about which treatment to use. This highlights the fact that women can be making uneducated decisions about MHT which may mean they are missing out on the best treatment for them.

With many women worried about the impact of hormones on the breast it is important to explain available data. Although studies have suggested that use of MHT will lead to an increase in breast cancer, data shows this is dependent on the type of MHT involved. Whilst some androgenic derived progestins seem to increase risk, evidence from the E3N and Finnish studies suggest that natural progesterone and dydrogesterone do not.

Family history of breast cancer can also play a large part in treatment decisions and should be explored. Women with the BRCA1 gene have a 70% breast cancer risk whilst women with BRCA2 gene have a 40-50% breast cancer risk. However evidence shows this risk is not added to by use of MHT as WHI studies have confirmed there is no increased risk of breast cancer in those with a family history of the disease. Studies such as DUPONT and BRYNE have also shown there is no increased risk of breast cancer in MHT users with a history of benign breast pathology or atypical hyperplasia.

As a result, Dr Marie-Scemama advises you explain the risks to patients in the following way:

“The medical evidence shows that there is a slight increase in the risk of breast cancer with certain HRTs when used 5 years or more; but this risk may be comparable to the risk of breast cancer associated with consuming 2 or more alcoholic drinks per day.”

Dr Marie-Scemama also suggested following NICE guidelines by expressing the following:

  • the baseline risk of breast cancer for women around menopausal age varies from one woman to another according to the presence of underlying risk factors
  • MHT with oestrogen alone is associated with little or no change in the risk of breast can
  •  MHT with oestrogen and progestogen can be associated with an increase in the risk of breast cancer any increase in the risk of breast cancer is related to treatment duration and reduces after stopping MHT

In order to find the best option for your patient and ease fear, it’s essential to look at the data available and analyse the risks and benefits of MHT. It’s important to remind patients that in most cases MHT is not associated with an increased risk of breast cancer and has even been shown to reduce mortality from breast cancer as demonstrated by the Finnish Nationwide Study.

Did you enjoy hearing about the best ways to communicate with patients? Next we’ll be sharing a patient case from today’s Ask the Expert session!

References

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2.       Lyytinen H, Obstet Gynecol, 2009; 113: 65-73

3.       WG WHI I; JAMA 2002; 288: 321-333

4.       Rohan, Cancer Epidemiol Biomarkers Prev 2008;17(9):2337–43

5.       NICE guideline NG23. “Menopause: diagnosis and management”, Published November 2015.

6.       Mikkola TS and all. Menopause 2016 Nov;23(11)1199-1203