[Breast cancer and hormone replacement therapy]

There are more than 50 studies and at least 6 metaanalyses with varying results concerning breast cancer risk related to hormone replacement therapy. According to the literature the breast cancer risk in hormone replacement therapy may be slightly increased, especially after long-term treatment. After discontinuing hormone therapy the risk decreases and reaches baseline 5 years later. Since prospective randomised studies are lacking, it is still unclear whether hormone replacement therapy really promotes breast cancer or if the increase is due to methodological biases such as more frequent breast examination or mammography. According to the literature there is no evidence that under hormone replacement therapy the risk of relapse is elevated or the prognosis less favourable in women treated for breast cancer. Since prospective randomised studies with long-term follow-up are lacking, we recommend the use of the guidelines of the "Deutsche Gesellschaft für Senologie", based on oestrogen receptor levels and lymph node involvement. Risks and benefits of hormone replacement therapy should be discussed with the well-informed patient and alternative therapy modalities evaluated.