Hormone Evaluation

Hormone Safety in a Patient with Cancer

Creasman WT: Hormone replacement therapy after
cancers. Curr Opin Oncol.
2005 Sep;17(5):493-9.


 

PURPOSE OF REVIEW: The role of female hormones in estrogen-dependent cancers has been debated for years. This is particularly true of breast cancer. Retrospective, case, and cohort control studies usually have suggested no influence. The Women’s Health Initiative study in 2002, a prospective double-blind study, noted an increased risk of breast cancer if estrogen plus progesterone was given. In the estrogen-only arm of that study, a decreased (not significant) risk of breast cancer was noted. With this controversy, can estrogen be given safely to a woman who has been treated for breast cancer? The relation between endometrial cancer and unopposed estrogen is well established. With clear-cut evidence of this relation, is there evidence to suggest a role for replacement therapy in women who have been treated for endometrial cancer?

RECENT FINDINGS: Several case-control and cohort studies have noted either no increased risk or actually less risk of recurrence in women taking estrogen after therapy after breast cancer. Although the general consensus is that such a recommendation is contraindicated, the data do not support this admonition. The current data suggest that replacement therapy can be given to the woman who has been treated for endometrial cancer. SUMMARY: There seems to be little if any risk in giving hormone replacement therapy to women who have had breast or endometrial cancer. There are no data to suggest that hormone replacement therapy is contraindicated in women who have been treated for cervical or ovarian cancer.

Note: this article suggests that hormone replacement therapy is appropriate in patients previously treated with ovarian and cervical cancer.


Creasman WT: Breast cancer: the role of hormone therapy. Semin Reprod Med. 2005 May;23(2):167-71.

The possible association of estrogen (E) with or without progestin (P) and breast cancer has been addressed in many studies for several decades. The recent reported prospective double-blind Women’s Health Initiative (WHI) study suggests that E + P increases the risk of breast cancer if a woman is an average of 63 years old when she begins replacement therapy. One third of the patients in this study were 70 to 79 years of age when E + P was begun–obviously several decades past menopausal. Retrospective and observational studies suggest protection or no increased risk. The WHI-E only study actually notes a 23% reduction in breast cancer compared with the placebo. It would appear from a review of the literature that if there is an increased risk for breast cancer with E or E + P, it is minimal.

Note: this article suggests that hormone replacement therapy is appropriate in patients previously treated with ovarian and cervical cancer.

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