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Hormone Therapy After Breast Cancer

The hormone estrogen is associated with the development of breast cancer. Anti-estrogen treatment with tamoxifen or ovarian ablation improves survival rates for women with the disease. However, can women with breast cancer safely use hormone therapy (HT) to ameliorate menopausal symptoms? These investigators reviewed records of 2755 women aged 35 to 74 who were diagnosed with invasive breast cancer from 1977 through 1994 at an HMO in Washington state. The HMO's existing Cancer Surveillance System and pharmacy data on HT use were used to identify 174 HT users and 695 nonusers and to compare breast cancer recurrence, mortality, and total mortality in the 2 groups. New primary contralateral breast cancers were not counted as recurrences. Median follow-up was 3.7 years for recurrence and 4.6 years for mortality.

Of the HT users, 43 percent used only vaginal HT (cream), 41 percent used only oral HT, and 16 percent used both; 79 percent of these preparations were estrogen alone. Sixteen recurrences occurred in HT users versus 101 in nonusers (9 percent vs. 15 percent; adjusted relative risk, 0.50; 95 percent CI, 0.30-0.85). During follow-up, 17 users and 115 nonusers died (10 percent vs. 17 percent; ARR, 0.48; 95 percent CI, 0.33-0.90). Duration of HT use, form of administration (vaginal vs. oral), or dosage did not affect either result. New contralateral breast cancers were diagnosed in 10 users and 26 nonusers (6 percent vs. 4 percent).

Comment: The substantial difference in risk for all-cause mortality among users and nonusers in such a short follow-up period and the lack of a duration, vehicle, or dose effect suggest that the women who chose HT were a selected group. A cautious approach would advise against routine HT use in women with breast cancer. Alternative approaches to treating debilitating menopausal symptoms include using the vaginal estrogen ring (which has little or no systemic absorption) for vaginal dryness and genital atrophy; bisphosphonates, exercise, and calcium for the prevention and treatment of osteopenia and osteoporosis; and selective serotonin reuptake inhibitors (e.g., venlafaxine, paroxetine) and progestational agents (e.g., megestrol) for vasomotor symptoms.

— CD Berg

Published in Journal Watch Women's Health August 1, 2001

Citation(s):

O'Meara ES et al. Hormone replacement therapy after a diagnosis of breast cancer in relation to recurrence and mortality. J Natl Cancer Inst 2001 May 16 93 754-762.

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