Breast cancer is the most common type of tumor in the world (excluding non-melanoma skin tumors) and the leading cause of cancer death among females in Brazil, according to data from the National Cancer Institute (INCA). For Brazil, the number of new cases of breast cancer is estimated at 66,280 for each of the 2020-2022 triennium. (INCA). Female breast diseases are the most common in all Brazilian regions.
It does not have a single cause, since several factors are associated with its development, the most famous of which are: age, genetic, hereditary, hormonal, environmental factors, as well as reproductive history.
In Brazil and in the world, the incidence of cancer has been increasing in recent years. Case proportions among women under 35 have also increased: the incidence, which was historically 2%, is now between 4% and 5%.
Hormonal factors are mainly related to the stimulation of estrogen, whether it is produced by the body itself or obtained through hormone replacement. This hormone is responsible for stimulating breast cells until the end of menopause. From there, care comes in regarding hormone replacements.
The well-known hormonal therapy is recommended for women experiencing climacteric age primarily to help relieve symptoms typical of this phase, such as hot flashes, mood swings, insomnia, memory loss, joint pain, dizziness, decreased libido, and genitourinary symptoms. However, the main concern for many women is whether menopausal hormone replacement therapy can cause breast cancer.
According to the Inca, hormone replacement therapy, especially one that combines estrogen and progesterone, increases the risk of breast cancer.
Treatment is not recommended for those with a family or personal history of breast cancer, endometrial cancer, thrombosis and/or cardiovascular disease, precisely because it increases the risk of these problems.
The hormones used, the dosage and the time of treatment are determined by the specialist doctor after a careful assessment of the condition, taking into account the specifics of each patient.
The current British meta-analysis, i.e. an analysis of several studies conducted on the topic, was published in The Lancet and included data from more than 108,000 users who contracted the disease.
According to the research, while the overall risk for women between the ages of 50 and 69 years of developing breast cancer is 6.3%, those who used a combination of estrogen and progesterone — one of the most common hormone replacement therapies — for five years had an 8.3% risk increase. .
The study also showed that the risk persists even 10 years after stopping the use of the hormone, information that was not previously agreed upon among doctors. What drew attention in the current British study is the fact that HRT may have greater risks if it is used by women who are overweight or obese or by those who drink alcohol excessively.
After a certain age, it is expected that breast cells sensitive to female hormones no longer have this hormonal stimulus to reproduce. Alternative therapy will continue with this stimulation. If there are any cancer cells, it is like a trigger for those cells.
Even in the absence of an abnormal cell, continuity in the stimulus increases the chances of eventual emergence of some mutations that lead to tumorigenesis.
It is important that the woman is informed so that she can take this into account when deciding whether or not to undergo treatment. The patient needs to know that it is desirable that the replacement lasts no more than five years, since after this period the risks increase. Each patient should be individualized in the continuity of treatment beyond this period.
It is necessary for the woman and her doctor to assess the real need for the use of hormones at this stage of life, and if it is really necessary, in the window of opportunity, the application is made for the shortest possible time. There are other ways to try to deal with the effects of menopause on health and quality of life, such as physical exercise and diet control. The use of hormones must follow strict standards.
Thus, hormonal replacement, if necessary, should be judicious, discrete and of short duration, respecting the family history, the person’s disease and lifestyle.
Giovanna Fortunato is an obstetrician-gynecologist and specialist in endometriosis and infertility, a professor at HUJM and a member of the Eladium Clinic team.
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