Ménopause et risques carcinologiques

Abstract

Since the Women's health Initiative (WHI) study published in 2002, hormonal replacement therapy (HRT) prescription is discussed, especially concerning the risk of cancer, and breast cancer in particular. This calling into question led France to publish in 2004 ANAES and AFFAPS recommendations. From recent literature data published by the EMAS, the North American Society and CNGOF, this study aim to discuss cancer risk under HRT. The relative risk (RR) of breast cancer varies from 1.26 in the WHI study to 1.66 in the Million Women Study, with different results according to the interval between menopause and starting hormone therapy and the modalities of HRT (different data for estrogen-only hormone therapy, or within the type of progestogen used). However, impact of breast cancer decreases since 2004, in which role of HRT is difficult to specify. Part of HRT in ovarian cancer is controversial, data being discordant in recent studies and mainly involving estrogen-only hormone therapy. Regarding protective property in endometrial cancer, the dose and duration of progestogen therapy seem to be the main factors. At last, there is no evidence as regards the role of HRT in drop of colon cancer incidence or increased mortality by pulmonary cancer. These updates data must be part of patient information before introducing HRT, in order to get the best evaluation of individual risk and benefit of this treatment.