Hormone Replacement Therapy and Breast Diseases: A Matter of Concern for the Gynecologist

Abstract

Background: The carcinogenic effect of exogenous steroid hormones on the breasts is a matter of debate, causing confusion for physicians at the time of making prescriptions. This article, as part of a quadruple series about exogenous sex hormones and breast disorders, reviews the association of breast cancer and hormone replacement therapy (HRT) in the general population, women with benign breast disorders, women with personal or family history of breast cancer, and BRCA carriers. Methods: We accomplished an extensive search of the literature by using relevant keywords to identify pertinent cohort studies, clinical trials, and reviews. Then, we extracted all points regarding the question. Results: An extensive literature exists on the risk of breast cancer following HRT in the general population, and HRT has been mentioned as a risk factor for breast cancer, especially in recent, long-term users of combined formulations. However, there is still no consensus about it. Conversely, few studies have considered challenging issues like the use of HRT in breast cancer survivors and high-risk women. Conclusion: HRT up to 5 years can safely be used for management of menopausal symptoms in healthy women, and those with low-risk benign breast disorders. On the contrary, its use in high-risk women should be limited to refractory menopausal symptoms after describing potential harms to the patient.