Are older breast carcinoma survivors willing to take hormone replacement therapy?

Breast carcinoma survivors are the largest segment of the expanding cancer survivor community. As a result, there has been increasing discussion of the safety and efficacy of hormone replacement therapy for women with a past history of breast carcinoma. Little is known about the willingness of older breast carcinoma survivors to accept hormone replacement therapy for the alleviation of menopausal symptoms (such as hot flashes, vaginal dryness, and urinary incontinence) or for reduction in the risk of serious heart disease or osteoporotic hip fracture.

A structured decision analysis interview was conducted, in which visual aids were used to describe therapy and hypothetical risks of breast carcinoma recurrence. Subjects were presented with a series of scenarios in which a hypothetical woman might be experiencing one of several menopausal symptoms or might have a reduction in the risk of serious heart disease or osteoporotic hip fracture.

Thirty-nine disease free breast carcinoma survivors who were age 60 years or older were recruited to participate in a study that included interview and physical examination. Subjects were age 68.3 years on average and had been diagnosed with breast carcinoma an average of 3.1 years previously. The majority had received hormone replacement therapy at some point in the past. They showed high levels of functioning as measured by the RAND Short Form Health Survey. Willingness to take estrogen was evident only when the increase in the risk of breast carcinoma recurrence was small and when severe symptoms of menopause were present. Under the hypothetical conditions of this interview, 56.4% of these 39 breast carcinoma survivors would be willing to take estrogen if they had all 3 menopausal symptoms and their risk of breast carcinoma recurrence increased from 25% to 32%. In contrast, for the osteoporosis and heart disease scenarios (in which women were as yet asymptomatic), only 17.9% were willing to take estrogen to reduce the risk of hip fracture by 50% and only 28.2% were willing to take estrogen to reduce the risk of heart attack by 50% under the same assumption of a 7% difference in the risk of recurrence (from 25% to 32%).

Overall, the study findings demonstrate the reluctance of these older breast carcinoma survivors to take estrogen after a breast carcinoma diagnosis. There was an increased willingness to consider therapy if multiple symptoms coexisted and the possible risk of recurrence was small (13% compared with 10%). There was also no significant correlation between current menopausal symptoms and the willingness to take estrogen in the hypothetical situations posed in the interview. These findings suggest an important feasibility problem that must be addressed before hormone replacement clinical trials involving breast carcinoma survivors are launched.