HRT should no longer be used as a first choice treatment for preventing osteoporosis in women, the Government's health advisers say, because it could increase the risk of breast cancer. STEPHEN LEWIS reports on the pros and cons of hormone replacement therapy.

A HEADLINE in one national newspaper yesterday screamed: 'Ban for HRT in cancer warning'. It was par for the course as far as media coverage of the latest HRT 'scare' was concerned, with even the Evening Press warning of a 'health alert on HRT treatment'.

Both headlines were perfectly correct as far as they went - which just goes to show how important it is that you read on beyond the headlines.

Yes, the Government's health advisers have recommended that hormone replacement therapy should no longer be the first choice of treatment for the long-term prevention of osteoporosis, a debilitating condition that causes thinning of the bones.

The reason? Taken in the long term, there is a small increase in the risk of developing breast cancer - a risk that increases the longer you take HRT. And on balance, experts have decided, that risk outweighs the benefits of taking HRT purely as a way of preventing osteoporosis.

However, it is still a very effective treatment for the relief of menopausal symptoms. The same Government health advisers are clear on this point. Used for the short-term relief of such symptoms, the benefits outweigh the risk for most women.

York GP Dr Sarah Bottom has been taking HRT herself for more than five years - and has no plans to stop. "I'll probably take it until I retire, because I'm such a ratbag if I don't," says the 56-year-old GP.

The problem with health 'alerts' such as this latest one over HRT is that people don't understand statistical concepts, she says.

Taken in the short term - anything between two to five years - the increased risks of developing breast cancer are small.

Something like 32 out of every 1,000 50-year-old women who do not take HRT will develop breast cancer by the time they reach 65.

For women who start to take oestrogen-only HRT at 50 and take it for five years, the figure is 33 or 34 out of every 1,000 - just an extra two cases. Take it for ten years, and the figure rises to 37 out of every 1,000.

With combined (oestrogen plus progestogen) HRT, the figures are slightly worse. For women who start combined HRT at 50 and take it for five years, the risk of developing breast cancer by 65 rises to 38 in 1,000. Take combined HRT for ten years, and it rises to 51 in 1,000.

Given the benefits she gets from taking HRT, it is a risk Dr Bottom says she finds acceptable. "I wouldn't say I'm not concerned, but I have an understanding of the risks." For women at risk of developing osteoporosis there are effective treatments which do not involve HRT, she says.

"HRT is the only really effective treatment for the symptoms of menopause, and in healthy women, used for the short-term control of menopausal symptoms, it is safe and effective," she says.

Heather Causnett agrees. She took HRT for 17 years - and never experienced any ill effects. On the contrary, she says, she avoided all the problems associated with the menopause that her own mother had had to put up with, and is convinced she remains healthier and more youthful to this day because she took the therapy.

On the advice of her GP she did, however, give up HRT in April, when the latest evidence about the increased risk of breast cancer among women taking HRT long-term first began to come out.

"And I have not felt as good since I came off it," says Heather, 70, from Escrick. "I feel I get more tired, and I'm not as flexible as I was."

Dr Bottom says that if women are really worried about breast cancer, the most effective way of reducing the risk is to adopt a healthy lifestyle - to keep fit and active, and eat a healthy, balanced diet. That is likely to have more of an effect than stopping HRT, particularly if you only take it for a few years.

It comes down to balancing the benefits of taking HRT against the possible risks. Advice at the moment is that for short-term relief of menopausal symptoms, the benefits of HRT outweigh the risks. But Dr Bottom accepts that there will be some women for whom any increase in the risk of breast cancer is unacceptable.

"So if you are one of those for whom there is no tolerable risk, then don't go on it," she says.

The best advice of all, however, for any woman worried about starting or remaining on HRT, is to speak to their doctor.

Updated: 10:09 Friday, December 05, 2003