Hormone replacement therapy for survivors of breast cancer

Abstract

Women with breast cancer who undergo therapies beyond the surgical intervention (chemotherapy, hormone therapy) often suffer from the lack of estrogens, manifesting as climacteric symptoms. Hormone replacement therapy (HRT) offers well-established clinical benefits for the relief of menopausal symptoms, improving quality of life, and may reduce the likelihood of osteoporosis and cardiovascular disease. However, HRT is generally considered to be contraindicated in breast cancer patients, as no firm safety data are yet available from randomised clinical trials. After publication of results of Women's Health Initiative (WHI) and One Million Women Study (MWS) randomised controlled trials, a majority of physicians do not find the need to prescribe HRT in breast cancer survivors, despite the fact that only prolonged use of HRT is associated with breast cancer in healthy women and the follow-up periods in these studies were relatively short. Moreover, a randomised trial, Hormone replacement therapy after breast cancer diagnosis, is it safe? (HABITS) was recently stopped because of negative results concerning breast cancer in the group of HRT users. Another randomised controlled trial, the Stockholm Trial, was also stopped preterm because of compliance and recruitment problems. When breast cancer survivors present with severe climacteric complaints and they ask for help, a pragmatic approach is justifiable as current evidence-based medicine fails to give a clear answer. In hysterectomised patients tibolone or low dose estrogen and in not hysterectomised patients tibolone or the combination of a low dose estrogen and a hormonal IUD for a short period of time could be considered.