Hormone replacement therapy in women with breast cancer. Do the risks outweigh the benefits?

• Published in: Journal of clinical oncology Vol. 14; no. 3; p. 997
• Main Authors: Roy, J A, Sawka, C A, Pritchard, K I
• Format: Journal Article
• Language: English
• Published: United States 01.03.1996
• Subjects: Breast Neoplasms - chemically induced; Cardiovascular Diseases - etiology; Cardiovascular Diseases - prevention & control; Cross-Over Studies; Estrogen Replacement Therapy - adverse effects; Estrogens - administration & dosage; Estrogens - adverse effects; Female; Humans; Meta-Analysis as Topic; Neoplasm Recurrence, Local - chemically induced; Osteoporosis, Postmenopausal - etiology; Osteoporosis, Postmenopausal - prevention & control; Postmenopause - drug effects; Postmenopause - physiology; Postmenopause - psychology; Progesterone - administration & dosage; Progesterone - adverse effects; Quality of Life; Randomized Controlled Trials as Topic; Risk
• ISSN: 0732-183X
• DOI: 10.1200/JCO.1996.14.3.997

To review critically the literature regarding effects of estrogen replacement therapy (ERT)/combined estrogen and progesterone replacement therapy (HRT) on the risk of breast cancer and on other health risks and benefits in postmenopausal women, with a focus on risks and benefits in women with a previous diagnosis of breast cancer. A literature search was conducted using Medline, Cancerline, and the bibliographies of reports published as of March 1995. All five published meta-analyses that examined the risk of breast cancer in relation to ERT/HRT in otherwise healthy women were critically reviewed. All known reports of women with a history of breast cancer given ERT/HRT subsequent to diagnosis and additional reports regarding the benefits of ERT/HRT were also reviewed. None of the five meta-analyses demonstrated a significantly increased risk of developing breast cancer in ever users compared with never users of ERT/HRT. Current use may be associated with a small increased risk. This increased risk should be balanced by the expected benefits of ERT/HRT on quality of life, bone metabolism, and cardiovascular function. Preliminary information does not suggest a major detrimental effect of ERT/HRT in women with a previous diagnosis of breast cancer, but these reports include few women with limited follow-up data. There are no randomized trials in women with a previous diagnosis of breast cancer. In healthy postmenopausal women, the benefits associated with ERT/HRT outweigh the risks. In women with a previous diagnosis of breast cancer, the balance of risks and benefits should be explored in randomized controlled trials.