HRT doubles the risk of ovarian cancer

LONDON: Women who undergo hormone replacement therapy (HRT) nearly double their risk of developing ovarian cancer. The largest such study ever, conducted by a team at Oxford University and involving 100 researchers worldwide, found that women who take HRT to combat symptoms of the menopause are 40% more likely to get one of the two most common types of ovarian cancer. The effect is just the same if HRT is taken even for just a few years.

The findings from a meta-analysis of 52 epidemiological studies, involving a total of 21488 women with ovarian cancer, almost all from North America, Europe and Australia, indicate that women who use HRT for just a few years are about 40% more likely to develop ovarian cancer than women who have never taken HRT.

"For women who take HRT for 5 years from around age 50, there will be about one extra ovarian cancer for every 1000 users and one extra ovarian cancer death for every 1700 users," says study co-author professor Sir Richard Peto from the University of Oxford. Although HRT use fell rapidly about a decade ago, this decrease has now levelled off and in the UK and USA alone about 6 million women are still taking HRT.

Existing WHO, US and European HRT guidelines do not mention ovarian cancer, and UK guidelines (currently being revised) state only that ovarian cancer might be increased with long-term use.

Previous studies had been too small to assess reliably the risks from just a few years of HRT use.

The international Collaborative Group on Epidemiological Studies of Ovarian Cancer analysed individual participant data from 52 studies — virtually all of the epidemiological evidence ever collected on HRT use and ovarian cancer.

There was a significantly increased risk of developing ovarian cancer in current or recent users (women who had used HRT within the past 5 years), but although the risk of ovarian cancer fell over time after stopping treatment, women who had used HRT for at least 5 years still had a somewhat increased risk of ovarian cancer 10 years later.

According to study co-author Professor Dame Valerie Beral "The definite risk of ovarian cancer even with less than 5 years of HRT is directly relevant to today's patterns of use — with most women now taking HRT for only a few years — and has implications for current efforts to revise UK and worldwide guidelines".

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