Новости о раке молочной железы

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Summary and Comment

Breast Tenderness After Starting Menopausal HT: An Ominous Sign?

In the WHI trial, HT users with new-onset breast tenderness had higher risk for breast cancer than did HT users without this side effect.


Breast tenderness is a common side effect associated with initiation of menopausal hormone therapy. In a report from the Women's Health Initiative estrogen-plus-progestin (E+P) trial, investigators assessed self-reported breast tenderness at baseline and after 12 months in relation to HT use and risk for breast cancer.

Among women without breast tenderness at baseline, incidence of breast tenderness at 12 months was threefold higher in participants assigned to HT than among those assigned to placebo (36.1% vs. 11.8%; P<0.001). Women who reported new-onset breast tenderness were older and more likely to be black or Latina than were women without this complaint. More than three quarters of participants who reported new-onset breast tenderness (most often rated as mild) had been assigned to HT. Users of HT who reported new-onset breast tenderness had 48% higher risk for breast cancer than did HT users who did not report this complaint (P=0.02). In contrast, new-onset breast tenderness in women who were assigned to placebo was not associated with elevated breast cancer risk.

Comment: Breast tenderness has been linked to high mammographic density, an independent risk factor for breast cancer. New-onset breast tenderness is also common among women when they begin HT and generally is dose-dependent. The results of this analysis suggest that new-onset breast tenderness predicts higher risk for breast cancer in women who use E+P HT. To put this excess risk in perspective, recall that the original E+P trial results showed that use of estrogen-progestin HT was associated with eight additional cases of breast cancer diagnosed per 10,000 women-years. The present analysis suggests that, if new-onset breast tenderness is present, absolute risk for breast cancer — although greater — is still relatively modest. Women who are considering initiating or continuing E+P HT should be counseled about its risks and benefits (as has long been recommended). Those women who experience new-onset breast tenderness upon starting E+P HT should discuss this condition with their clinicians, as it could affect decisions about HT choice, dose, and duration, as well as strategies for breast cancer surveillance.

Andrew M. Kaunitz, MD

Published in Journal Watch Women's Health November 19, 2009

Citation(s):

Crandall CJ et al. New-onset breast tenderness after initiation of estrogen plus progestin therapy and breast cancer risk. Arch Intern Med 2009 Oct 12; 169:1684.