Hormonal Replacement Therapy after Breast Cancer

  • Two randomized clinical trials were initiated and terminated early:
    • Due to an increase in breast cancer events:
      • In patients in the hormone replacement therapy (HRT) arm:
        • With a personal history of breast cancer
    • The HABITS (Hormonal Replacement Therapy after Breast Cancer – Is It Safe?) trial:
      • Randomized 442 patients:
        • With a personal history of breast cancer to HRT with estradiol with or without progesterone (based on the presence of a uterus) vs. nonhormonal symptom management:
          • More women in the HRT arm than the non-HRT arm had hormone receptor-positive breast cancer:
            • 62.3% vs 54.5%:
              • Approximately half of patients in each group had taken HRT before their diagnosis of breast cancer
        • At median follow-up of 4 years:
          • New breast cancer events occurred twice as frequently in the HRT group (hazard ratio [HR] 2.4) compared to the nonhormonal symptom management group
    • A similar trial in Stockholm:
      • Found no difference in breast cancer recurrence:
        • In patients randomized to HRT vs. no HRT at 11 years of follow-up:
          • But reported an increased risk of contralateral breast cancer in those receiving HRT (HR 3.6, p=0.013)
  • Estrogen alone can be used to reduce symptoms:
    • For postmenopausal women:
      • Without a personal history of breast cancer
      • Who have had a hysterectomy
    • Was associated with a nonsignificant lower risk of breast cancer in the Women’s Health Initiative trial at 13 years of follow-up (HR 0.79):
      • However, the WHI cohort did not include women with a personal history of breast cancer, and therefore these data cannot be extrapolated to this population
  • Expert guidelines recommend:
    • The use of topical low-dose vaginal estrogen therapy for women with bothersome genitourinary symptoms and contraindications to the use of systemic HRT:
      • This is a reasonable strategy in breast cancer survivors:
        • Due to the local nature of vaginal estrogen and its low systemic absorption
  • References
    • Holmberg L, Iversen OE, Rudenstam CM, Hammar M, Kumpulainen E, Jaskiewicz J, et al. Increased risk of recurrence after hormone replacement therapy in breast cancer survivors. J Natl Cancer Inst. 2008;100(7):475-482.
    • Fahlén M, Fornander T, Johansson H, Johansson U, Rutqvist LE, Wilking N, et al. Hormone replacement therapy after breast cancer: 10 year follow up of the Stockholm randomised trial. Eur J Cancer. 2013;49(1):52-59.
    • Manson JE, Chlebowski RT, Stefanick ML, Aragaki AK, Rossouw JE, Prentice RL, et al. Menopausal hormone therapy and health outcomes during the intervention and extended post-stopping phases of the Women’s Health Initiative randomized trials. JAMA. 2013;310(13):1353-1368.
    • The NAMS 2017 Hormone Therapy Position Statement Advisory Panel. The 2017 hormone therapy position statement of The North American Menopause Society. Menopause. 2017;24(7):728-753.

#Arrangoiz #BreastCancer #BreastSurgeon #CancerSurgeon #CASO #CenterforAdvancedSurgicalOncology #PalmettoGeneralHospital

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