One of the biggest fears people have around HRT is the report of an increase in the risk of breast cancer. While much has been done to dispel the myths around breast cancer risk other forms of cancer can be missed.
The risk of developing many cancers increases with age and some affect women more than men and vice versa. Oestrogen can protect against some cancers and increase the risk of others. Eating a healthy, balanced diet, high in fruit and vegetables, fibre, stopping smoking, reducing alcohol intake and increasing exercise are all ways to reduce the risk of developing cancer of any type.
What are the most common types of cancer in the UK?
In women in the UK the most common form of cancer is breast. In the years 2016-18 approximately 55,500 women were diagnosed with this form of cancer. Other most common forms in women are lung, (25,000); bowel, (24,000); Uterine, (10,000); Skin – melanoma, (8,500); Ovarian, (7,500). Any part of the body can develop a malignancy; however, this article will focus on these.
Most individuals will experience natural menopause between the ages of 45-55years; however, many individuals may experience early menopause due the surgical and/or medical treatment. Cancer treatments like chemotherapy and radiotherapy can lead to an induced menopause regardless of the age of the individual.
The biggest cause of lung cancer by far is smoking, including cigarettes, pipes, cigars, snuff and chewing tobacco. Other causes include exposure to radon, some occupational pollutants like asbestos, long-term exposure to diesel fumes and passive smoking.
A study conducted in 2021 indicated individuals who experience menopause prior to the age of 45years may be at higher risk of lung cancer, however, this is mainly amongst those who smoke. This research is only preliminary findings and far from conclusive but is another good reason to stop smoking.
The cause of bowel cancer is often unknown; however, the risks increase with age – 50+; smoking; overweight/obesity; close family link; history of certain bowel conditions like Crohn’s, Irritable Bowel Disease, Ulcerative Colitis, etc.
Early research into menopause and colorectal cancer at the turn of this century appears to indicate individuals who take HRT in peri/post menopause are less likely to develop colon cancer but did not appear to have any effect on rectal cancer risk. However, studies conducted in 2012 and 2016 reiterate the lower risk of colon cancer with HRT usage but indicate some protection for rectal cancer although lower than for colon.
Uterine, (Endometrial) Cancer
The causes of uterine/endometrial cancers are largely unknown but there is a link with increased levels of Oestrogen. Other known risk factors include overweight/obesity; never having given birth; Polycystic Ovary Syndrome; Late menopause – after age 55years; Diabetes; family history of uterine cancer; radiotherapy on the pelvic region; history of Tamoxifen usage.
As Oestrogen is a key component of HRT individuals must take Progesterone medication alongside. This can be in the form of a capsule or Mirena IUS. Progesterone helps to keep the endometrium – the lining of the womb, thinner to reduce the risk of this form of cancer. Whilst the risk is not completely removed individuals with a uterus/womb must still be vigilant for signs and symptoms of the disease.
Skin, (Melanoma) Cancer
Melanoma is the more serious form of skin cancer. The main cause is exposure to ultraviolet rays from sunlight or sunbeds. Anyone of any age can develop melanoma but some may be at higher risk including fair skin that burns easily; red or fair-haired people; highly freckled or moles; history of sunburn; high use of sunbeds; history of previous skin cancer or family history.
Prolonged exposure to the sun ages the skin and as oestrogen levels drop in peri/menopause the skin becomes thinner and more prone to melanoma development. Research into the use of HRT and an increased risk of Melanoma is limited but there does not appear to be a correlation between the two, but it is an area that requires more research.
Anyone who has ovaries can develop ovarian cancer, however the risk increases as the individual gets older. There is a higher risk for those who have an inherited gene like BRCA; a history of breast or bowel cancer; previous radiotherapy treatment; Endometriosis; Diabetes; early start of periods, late menopause or never had a baby; never used hormonal contraception, overweight/obese; smoking.
Research indicates there may be a slight increased risk of developing ovarian cancer when taking HRT however, the risk is believed to be small and should be weighed against the risk of long-term health conditions caused by menopause.
The risk of developing cancer in general increases with age. More research is needed into the risks of cancer and menopause especially in the use of hormone therapy. However, at any age, the best advice to help reduce the risk is maintaining a healthy lifestyle with diet, exercise, reducing alcohol and stopping smoking. Otherwise, vigilance is key, spotting and acknowledging signs and symptoms of any cancer early along with early diagnosis and treatment will greatly increase the chance of survival.
If you have access to myTamarin virtual support with your employer and would like to discuss any concerns around Menopause book a 1-1 appointment with a specialist at myTamarin via your company-specific landing page or app.
NHS, (2022) Lung Cancer - Causes. www.nhs.uk
Mishra, G., (2021) Early Menopause Linked to an Increased Risk of Lung Cancer. www.medicine.uq.edu.au
Botteri, E., et al, (2023) Menopausal Hormone Therapy and Colorectal Cancer. www.bmjopen.bmj.com
NHS, (2021) Womb (Uterus) Cancer – Causes. www.nhs.uk
NHS, (2023) Melanoma Skin Cancer – Causes. www.nhs.uk
American Academy of Dermatology Association, (2023) Caring for Your Skin in Menopause. www.aad.org
Hicks, BM., et al, (2019) Hormone Replacement Therapy and the Risk of Melanoma in Post-Menopausal Women. www.pubmed.ncbi.nlm.nih.gov
NHS, (2022) Ovarian Cancer – Causes. www.nhs.uk
Target Ovarian Cancer, (2023) Ovarian Cancer Risk. www.targetovariancancer.org.uk
Macmillan Cancer Support, (2021) Menopausal Symptoms and Cancer Treatment. www.macmillan.org.uk
The Menopause Charity, (2023) Menopause and Cancer. www.themenopausecharity.org
Cancer Research UK, (2023) Cancer Incidence for Common Cancers. www.cancerresearchuk.org