Menopausal estrogen replacement therapy in women with breast cancer

Abstract

The role of estrogen replacement therapy (ERT) in women with a history of breast cancer is currently a subject of considerable controversy. Traditionally, ERT was believed to be absolutely contraindicated in women who had ever had a diagnosis of breast cancer. This dogma, however, was based more on theoretic considerations and on extrapolation from laboratory models than on the availability of clinical data documenting risk. Now that ERT or hormone replacement therapy (HRT, estrogen with progesterone) is routinely recommended for periand postmenopausal women, it is not surprising that the role of ERT or HRT in women who have had breast cancer has become a subject of increasing interest. It is now widely thought that for healthy women approaching menopause, the short and long term benefits of ERT probably outweigh the risks. Of course, it has long been accepted that such therapy alleviated, at least partially, the more common immediate symptoms of menopause, such as vasomotor disturbances (hot flashes), vaginal dryness, and urinary symptoms, such as frequency and dysuria.' Furthermore, this relief of short term symptoms has now been clearly demonstrated in randomized trials.' Recent studies have also demonstrated impairment in quality of life related to menopausal symptoms and improvement in quality of life with the use of ERT.3 Although it has been documented that the administration of ynopposed estrogen to postmenopausal women is associated with an increased risk of developing endometrial ~ a n c e r , ~ this risk can be largely avoided if progesterone is given c~ncurrently.~,~ An increased risk of developing breast cancer in women previously