by Vera Martinella
The association has mostly been seen in studies with drugs that are no longer used. The usefulness of the treatment must in any case be assessed on a case-by-case basis. What are the potential risks and what are the benefits
Hormone replacement therapy increases the risk of certain types of cancer, so it is advisable to limit its use: one of the 12 key points contained in the European Code against Cancer, the document coordinated by the International Agency for Research on Cancer (IARC) on behalf of the World Health Organization. Our recommendations are against the use of hormone replacement therapy: the conclusion reached by the Preventive Services Task Force, an important group of American public health experts, in a review published in the scientific journal with the intention of updating what was established in 2017 and confirmed in this new opinion.
Because it is prescribed
Hormone replacement therapy (HRT) can be taken by mouth, in pills, but today it also exists in the form of patches, gels, creams and above all with hormones identical to those of women. If HRT is dangerous why is it prescribed? What are the potential risks and what are the benefits? Menopause occurs following the cessation of production by the ovaries of reproductive hormones (estrogens) and hormone replacement therapy, a treatment based on female hormones used to relieve the symptoms of menopause, recalls Paolo Veronesi, director of the Senology Program and director of the Surgical Breast Division of the European Institute of Oncology in Milan.
Symptoms reduced or eliminated
The assumption of this therapy, which consists in the administration of estrogens, almost always associated with an adequate dose of progestogens, goes to “compensate” those that are lost with the end of the menstrual cycle, in order to bring the organism back to a situation of balance similar to the period before menopause, reducing or eliminating any symptoms (i.e. hot flashes, insomnia, vaginal dryness, pain during sexual intercourse) – continues Paolo Veronesi, who is also president of the Umberto Veronesi Foundation — . There are two main points: first, the Tos must be decided on the basis of various criteria and prescribed “tailor-made”, evaluating a set of parameters on a case-by-case basis; second, the various current treatments are better than those used in the past, on which the studies that have led to the conclusions contrary to Tos are based.
Replacement therapy and ischium of breast cancer
Hormone replacement therapy
can it increase the risk of breast cancer? The link between hormone replacement therapy and breast cancer has been one of the main fears of women since, in 2002, a large American study observed a slight increase in cases of breast cancer in women who took estrogen and progestogens – replies Alessandra Gennari, director of the Oncology unit of the Maggiore Hospital of Novara —. Since then, a climate of strong distrust has spread towards hormone replacement therapy which, however, is not justified: the increase in the risk of breast cancer is, in fact, very small; it also refers to estimates conducted on women who have taken drugs that are rarely used in Italy, where instead molecules closer to those naturally produced by the body are preferred, and at higher doses than those in use in our country. Finally, it is linked to very long hiring periods (more than five years). therefore it is reasonable not to completely eliminate the possibility of resorting to hormone replacement therapy especially if the disturbances associated with menopause are very intense.
Danger of other cancers?
Is there a danger of other tumors? Several studies have also indicated a slightly increased risk of endometrial tumors linked to therapies based on the administration of estrogen alone, which are no longer prescribed today – says Alessandra Gennari, full professor of oncology at the University of Eastern Piedmont -. Furthermore, these are studies that began many years ago and refer to “old” drugs (now considered obsolete). That is: if in the past the risk was there, even if rather low, today with the use of modern hormone replacement therapies it is even more limited. it is important to carry out the therapy in strictly necessary cases indicated by the doctor, at the minimum effective doses, with the latest generation products, relieving the symptoms of menopause. In support of HRT, however, it should be emphasized that all studies observed a decrease in the risk of developing colon cancer.
When not indicated and side effects
Who should avoid it? Women with previous breast cancer, especially if estrogen-dependent, those who have had a heart attack, stroke, thromboembolism. And in any case, the use of HRT should always be discussed with a gynecologist, explains Veronesi. What are the side effects of Tos? We are talking about mild effects, such as swelling or vaginal bleeding that can be solved by changing the therapy or which often disappear spontaneously within a few weeks. Then there is the thromboembolic risk to evaluate, with medium-high dose oral therapies started after the age of 60 concludes Gennari.
Benefits
Which women can benefit the most? Not all women have to undergo hormone therapy: the right candidates are those with vasomotor symptoms, the classic hot flashes, because these are directly related to a greater risk of cardiovascular diseases and osteoporosis. Then there may be women for whom it is still recommended, for example to prevent osteoporosis or to solve a genitourinary syndrome explains Alessandra Gennari. It is always necessary to evaluate the indication on a case-by-case basis and then, once it has been decided that TOS could be a solution, it is still necessary to consider the characteristics of the patient. it is advisable to have a mammogram because TOS can modify the structure of the breast and it is good to have a clear starting point; a Pap test is also needed, because at menopause there is a second peak of Papilloma virus (Hpv) infection.
August 25, 2023 (change August 25, 2023 | 07:24)
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