June 2002 · Vol. 14, No. 6Weighing HRT use after breast cancer
HRT has long been contraindicated in women who have—or have had—breast cancer. Here, the author examines the effects estrogen has on the breast and reviews several studies that suggest HRT actually may be of benefit to these women.
WILLIAM
CREASMAN,
MDDr. Creasman is the J. Marion Sims Professor of OBG at the Medical University of South Carolina in Charleston.
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Key points
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Eighty percent of the approximately 205,000 women expected to develop breast cancer this year will be succesfully treated.
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The data to date suggest that HRT in the patient who has had breast cancer is not detrimental. Some larger studies note fewer recurrences and breast cancer deaths, and less total mortality in HRT users.
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The absolute risk of breast cancer in a 10-year HRT user is 0.6%.
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Fifty-nine percent of premenopausal breast cancer patients are willing to consider eventually taking HRT.
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This year, almost 50,000 women under the age of 50 will develop breast cancer. Most will undergo chemotherapy and become amennorhic. It is well known that premature surgical menopause usually results in more significant vasomotor symptoms than a natural menopause. It certainly follows that women who have had a chemotherapeutically-induced menopause will have a similar experience.
Hormone replacement therapy (HRT) has proven efficient in the treatment of vasomotor symptoms. Many women also take HRT for good urogenital health, primary cardiac protection, and to assist in the prevention of osteoporosis, colon cancer, and possibly Alzheimer’s disease. In some studies HRT has been linked to an increased risk of breast cancer due to prolonged estrogen exposure; however, the data are inconclusive.
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