HRT vs. Hormonal Treatment: A Case of Mistaken Identity

Both hormone replacement therapy and hormonal treatment for breast cancer have made headlines in recent years, leading to some confusion. This common mix-up is further complicated by the fact that hormone replacement therapy is not recommended to most women with breast cancer.
In truth, hormone replacement therapy and hormonal treatment for breast cancer have completely opposite goals. While one works to replace estrogen in a woman's body, the other tries to eliminate it. Below, Dr. Debu Tripathy, director of the breast cancer research program at the University of Texas Southwestern Medical Center in Dallas, explains the difference between these two medical therapies.

Do patients often confuse hormone replacement therapy and hormonal treatment for breast cancer?
There is some confusion between hormonal treatment and hormone replacement therapy. Hormone replacement therapy usually refers to the use of estrogen or estrogen-containing treatment to alleviate some of the side effects of menopause. Hormonal treatment refers to treatment for breast cancer or, in some cases, breast cancer prevention, which reduces the effect of estrogen on breast tissue or breast tumor tissue.

What is hormone replacement therapy?
Hormone replacement therapy is designed to replace estrogen in women after menopause, when estrogen levels fall. The intent is, number one, to help with menopausal symptoms and, number two, to help with other health benefits that might be associated with estrogen.


What are the different uses for hormone replacement therapy, both short term and long term?
The use of hormone replacement therapy in the short term is mostly for alleviating side effects of menopause, such as hot flashes and, in some cases, mood swings. And these are used for a short period of time and are generally effective.

We used to think that long-term estrogen replacement or hormone replacement therapy could also combat things like heart disease and other processes of aging, like Alzheimer's disease and skin wrinkling. But the Women's Health Initiative study was really the first randomized study to look at the effect of estrogen replacement in women after menopause. This study took women at the time of menopause and randomly assigned them to either placebo, a sugar pill, to estrogen alone or to the more common combination of estrogen and a progesterone agent.

We knew that hormone replacement therapy could increase the risk of breast cancer by a small amount, but we were hoping that the increased breast cancer risk would be counteracted by a reduction in the much more common problem of heart disease. However, what we found is that there were actually more heart attacks and other cardiac events, as well as the known increase in breast cancer.

HRT vs. Hormonal Treatment: A Case of Mistaken Identity
Related Programs:
Hormone Replacement Therapy vs. Hormonal Treatment: What's the Difference?

Talking to Your Doctor About Early-Stage Breast Cancer

What is Hormone Receptor Positive Breast Cancer?

A Good Doctor-Patient Relationship in Breast Cancer

Managing Side Effects of Hormonal Treatments For Early Stage Breast Cancer


There were also some older studies that showed that estrogen replacement might help with dementia, but these were not controlled studies. In other words, they didn't compare a group of women that were not getting estrogen to a group that did. More recently, randomized studies have shown that there does not seem to be an effect on decreasing dementia from estrogen replacement. So this, again, goes against some of the commonly held beliefs.
How would you summarize the current thinking about whether women should be on hormone replacement therapy, based on the results from the Women's Health Initiative study?
The current thinking on hormone replacement or estrogen replacement now is that we should primarily use it short term, from a few months to, at most, a year or two, to alleviate side effects of menopause. To use it long term in hopes of lowering the risk of heart disease, at the current time, is simply not supported by the findings of the recent studies.

What is hormonal treatment for breast cancer?
Hormonal treatment for breast cancer is designed to block the effect of estrogen on either normal breast tissue or breast cancer cells. In some breast cancer tumors, estrogen can stimulate growth. There are tests called the estrogen receptor and progesterone receptor tests, which help determine if a tumor is responsive to those hormones. If either of those tests is positive, then we will typically use hormonal treatment.

Examples of hormone treatment include removing the source of estrogen itself, by removing the ovaries or by using medications to keep the ovaries from producing estrogen. Another method involves using drugs that interfere with the effect that estrogen has on breast cells or breast cancer cells. These drugs include tamoxifen and a class of drugs called aromatase inhibitors.


For people with early-stage breast cancer who are cured with surgery, we know that, in some cases, we can lower the risk of the cancer coming back with the use of hormonal treatment after breast surgery.

Advanced breast cancer, when the cancer has already spread, is not curable. But hormonal treatment can, in some cases, keep the cancer in check, sometimes for a very long time.

And then there is recent information that using hormonal treatment?particularly one type called tamoxifen?can lower the risk of getting breast cancer in someone who might be at higher risk.

When would you consider using tamoxifen in a woman without cancer?
The use of tamoxifen to prevent cancer, that is, in someone who does not have cancer and who's never had cancer, is considered in women who are at high risk for breast cancer. For example, women who have had a biopsy that did not show cancer, but did show some changes that we know predispose people to breast cancer, would be considered high-risk. Other women who might benefit from tamoxifen might be those who have a family history of breast cancer, or who started their periods earlier; those are also slight risk factors.

Is hormonal treatment ever used before surgery for breast cancer?
Yes, though that isn't quite fully tested yet. It's called neoadjuvant hormonal therapy, and it refers to using hormonal treatment in someone who is going to have breast surgery for early stage breast cancer, but has medical treatment first. Studies have shown that you can actually shrink tumors and make the surgery easier when you use hormonal treatment prior to surgery . These people still need to get long-term hormonal therapy as well, that is, five years of therapy following surgery.

How do you clear up confusion between hormonal treatment and hormone replacement therapy?
My technique for clarifying between hormonal treatment for breast cancer and hormone replacement therapy is to explain the biology to the patients. I explain that some breast cancers stop growing (or grow more slowly) based on lowering the level of estrogen, so we want to use hormone treatments that accomplish that. For women who are having menopausal symptoms, hormone replacement is used to try to replace the effects of estrogen.

http://womens_health.healthology.com...ml_hrt&spg=FLA