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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

New HRT Risk Data

Last week the Medicines and Healthcare products Regulatory Agency issued an update after new data on breast cancer risk linked with HRT use were published.

This new analysis, published in The Lancet was a prospective, observational study of over 100,000 women. The study extended our understanding as follows:

  • All forms of systemic HRT are associated with a significant excess incidence of breast cancer, irrespective of the type of oestrogen or progestogen or route of delivery
  • Risk of breast cancer increases further with longer duration of HRT use
  • Risk of breast cancer is lower after stopping HRT than it is during current use, but remains increased in ex-HRT users for more than 10 years compared with women who have never used HRT

More reassuringly, the study also found that use of systemic HRT for less than a year is associated with little or no increase in risk and there is also no increase in risk with low doses of oestrogen applied directly via the vagina to treat local symptoms.

New risk tables have been produced to aid communication about risks and benefits. Table 1 summarises risk compared to duration of use while Table 2 summarises risk by HRT type.

The MHRA are advising that this new information is shared with women who use or are considering starting HRT at their next routine appointment. It is also recommended that HRT is used for the shortest time and at the lowest dose to relieve post-menopausal symptoms that are adversely affecting quality of life and that users are advised to be vigilant for signs of breast cancer and attend for breast screening.

Action: Clinicians who prescribe HRT should be aware of this new data and include this new information when discussing the risks and benefits of treatment.

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