October 6, 2001
Lecturer recommends hormone replacement therapy for breast cancer survivors
BY DENNIS CONNAUGHTON
Many women fear taking hormone replacement therapy because it has been linked to an increased risk of developing breast cancer. In addition, medical experts have in the past considered HRT to be contraindicated for women who have survived breast cancer.
However, in a lecture presented Thursday afternoon as part of AAFP's Annual Clinical Focus 2002: Cancer, R. Don Gambrell Jr., M.D., examined both of those ideas and came to very different conclusions. He is clinical professor of endocrinology, obstetrics and gynecology at the Medical College of Georgia, Augusta.
STUDIES OF RISK
As to the notion that HRT increases the risk of breast cancer, Gambrell cited a multitude of studies on the effects of HRT use. "Only one study out of 55 has found a significant increase in breast cancer in their total patient population [of estrogen users], and that is the Nurses' Health Study" of 1995, he said.
"Unfortunately, the Nurses' Health Study is the one always quoted by the news media when the controversy over estrogen use arises. Other recent studies find no increased risk of breast cancer with estrogen or estrogen-progesterone use," Gambrell said.
He concluded from reviewing the medical literature on the uses of estrogen and combined estrogen-progesterone therapy in women: "Estrogen therapy does not increase the incidence of breast cancer. Added progesterone probably decreases the risk, but that is being questioned now. Very clearly, the prognosis of breast cancer has improved, most likely due to early detection."
BREAST CANCER SURVIVORS
As to the use of HRT in women treated for breast cancer, he asked, "If estrogens do not increase the risk of breast cancer and added progesterone probably decrease the risk, and the prognosis has improved due to early detection, why can't we give estrogens to women who have had carcinoma of the breast?"
Although no studies show HRT increases the risk of recurrences or mortality in postmenopausal women who have had breast cancer, few studies show it does not increase the risk, Gambrell said. Randomized, prospective studies are now under way to determine the long-term effects of HRT in breast cancer survivors, but it will take 10 or 15 years to get the results.
Based on the 10 studies available on HRT use in survivors of breast cancer, including one in which he was involved, Gambrel concluded, "Our study confirms other studies showing that estrogen use in breast cancer survivors does not increase recurrences, and the addition of moderate doses of progesterone may even decrease recurrences and mortality from carcinoma of the breast."
FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
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