Hormone Replacement Therapy in Postmenopausal Patients with a History of Breast Cancer – Is it Safe?

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • 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%), and 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, and 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.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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