[Hormonal replacement therapy and breast cancer]

The recent publication of some randomised control trials results and of two important cohort studies makes possible a better understanding of the relation between hormonal replacement therapy (HRT) and breast cancer. It is now well established that estrogen-progestin replacement therapy is associated with an elevation of breast cancer risk. It is not possible to define duration of treatment without risk. Data for estrogens alone are discordant. Five years after stopping HRT, the risk will join the level of non-users. By now, HRT may be prescribed in women that suffer intense climacteric symptoms, and after careful information about benefits, risks, and mammary effects of HRT. The minimal dose of estrogens is required for the control of menopausal symptoms. Estrogens alone will be prescribed in hysterectomised women. Mammography has to be performed before the beginning of HRT, and then every two years, in the absence of important risks factors of breast cancer. The indication of HRT has to be discussed every year, and some therapeutic pauses must be planned. In case of increased breast density at mammography, ultra-sonography may be useful. Breast surveillance must go on after HRT termination.