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Prof. Anne Gompel, gynecologist-endocrinologist : The study by Dr. Françoise Clavel, research director at Inserm, which concerns the so-called “French-style” treatment (local estrogen and natural progesterone), concludes at a risk of breast tumor multiplied by 1 , 3 for 8 years of use.
When treatment is stopped, the increased risk disappears very quickly. So there is a risk, but it is modest. How many more cancers does this correspond to? It all depends on the initial risk, because multiplying a low risk by 1.3 is not the same as multiplying a high basis risk by the same ratio.
In a recent study, we show that for women at low initial risk, hormone therapy for menopause results in an additional 4 cases of cancer per 1,000 women treated for 7.5 years. This is not nothing, but it remains moderate, especially since there are benefits to be weighed.
Top santé: And in practice, what lessons do you draw from it?
Pre Anne Gompel : The idea is to select the patients who are offered this treatment on the basis of their initial risk. And above all, to change the look on the menopause consultation. This can be an opportunity to help women take advantage of this moment to put their lifestyle in order and thus reduce their risk of breast cancer.
In our consultation, we see a lot of women who present risks (cancer, venous thrombosis, osteoporosis …), they come to us because their doctor is reluctant to prescribe them a THM. For each, we establish a risk-benefit balance. The most complicated are the women who have had breast cancer, because HRT remains contraindicated.
But we can offer alternatives such as norepinephrine and serotonin reuptake inhibitors. These antidepressants have an interesting effect in the management of hot flashes. For women who cannot or do not want to take antidepressants, there are still solutions such as acupuncture, yoga, relaxation or even certain non-prescription treatments such as Acthéane® or Sérélys®, whose effectiveness is marginal.
In search of the magic pill
A new concept, TESC (“Tissue-Selective Estrogen Complex”) appeared a few years ago. It involved combining several molecules to simultaneously have the protective benefits of estrogen without the disadvantages. In other words, having the effect of estrogen on the organs you want without impacting the organs at risk like the breast and uterus. If the first drug was a commercial failure, research continues. “In nature, there are phytohormones in plants with varying effects from plant to plant,” explains Dr Jamin, who is working to identify these substances in order to find the right mixture to replicate the TESC effect. The good news is that this research is very advanced … A case to be continued.
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