Hormone replacement therapy in women with breast cancer: Do the risks outweigh the benefits?

Purpose: To review critically the literature regarding effects of estrogen replacement therapy (ERT)/combined estrogen and progesterone replacement therapy (HRT) on the risk of breast cancer and on other health risks and benefits in postmenopausal women, with a focus on risks and benefits in women with a previous diagnosis of breast cancer. Method: A literature search was conducted using Medline, Concerline, and the bibliographies of reports published as of March 1995. All five published meta-analyses that examined the risk of breast cancer in relation to ERT/HRT in otherwise healthy women were critically reviewed. All known reports of women with a history of breast cancer given ERT/HRT subsequent to diagnosis and additional reports regarding the benefits of ERT/HRT were also reviewed. Results: None of the five meta-analyses demonstrated a significantly increased risk of developing breast cancer in ever users compared with never users of ERT/HRT, Current use may be associated with a small increased risk, This increased risk should be balanced by the expected benefits of ERT/HRT on quality of life, bone metabolism, and cardiovascular function. Preliminary information does not suggest a major detrimental effect of ERT/HRT in women with a previous diagnosis of breast cancer, but these reports include few women with limited follow-up date. There are no randomised trials in women with ct previous diagnosis of breast cancer. Conclusion: In healthy postmenopausal women, the benefits associated with ERT/HRT outweigh the risks, In women with a previous diagnosis of breast cancer, the balance of risks and benefits should be explored in randomized controlled trials. (C) 1996 by American Society of Clinical Oncology.