Hormone replacement therapy after a cancer diagnosis

Abstract

The issues of hormone replacement therapy are of concern to every woman but must be increasingly confronted by young cancer patients experiencing premature menopause from oncologic treatments. These young women join the millions of breast, ovarian, and endometrial cancer survivors who live in an estrogen-deficient state, with its attendant risks and side effects. Although recurrences are foremost of the patient’s concerns, the morbidity and mortality from cardiovascular disease, stroke, and osteoporosis present a 7- to 10-fold greater threat, and therefore these issues need to be placed in perspective. Although there is extensive literature available to the primary care provider documenting the positive effects of estrogen on bone structure, cardioprotective properties, and reversal of genitourinary atrophy, there is a dearth of high-level evidence about the safety of hormonal therapy in cancer survivors. This article will review the current epidemiologic evidence for hormone replacement therapy with emphasis on the risks and benefits for the cancer survivor, especially in women successfully treated for breast and endometrial cancers. An approach to an informed decision-making process for the patient, in concert with her primary care provider and oncologist, will be outlined. (Prim Care Update Ob/Gyns 2002;9:85–89.