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[Hormonal replacement therapy and breast cancer]
1Service de chirurgie à orientation sénoloqique, Institut Curie, 26, rue d'Ulm, 75231 Paris Cedex 05. pascale.this@curie.net
La Revue Du Praticien
|April 15, 2005
Summary
Hormonal replacement therapy (HRT) with estrogen-progestin increases breast cancer risk. While risk returns to baseline five years post-HRT, careful patient selection and monitoring are crucial for managing menopausal symptoms.
Area of Science:
- Oncology
- Endocrinology
- Women's Health
Background:
- Recent randomized controlled trials and cohort studies provide new insights into hormonal replacement therapy (HRT) and breast cancer.
- Estrogen-progestin HRT is definitively linked to increased breast cancer risk.
Purpose of the Study:
- To clarify the relationship between HRT and breast cancer risk based on recent evidence.
- To provide guidance on the appropriate use of HRT for menopausal symptom management.
Main Methods:
- Review and synthesis of data from randomized controlled trials and cohort studies.
- Analysis of breast cancer risk associated with different HRT formulations and durations.
Main Results:
- Estrogen-progestin HRT is associated with elevated breast cancer risk; risk returns to non-user levels five years after cessation.
- Data on estrogen-only HRT remain discordant.
- No specific safe duration of HRT can be defined.
Conclusions:
- HRT may be prescribed for severe menopausal symptoms after thorough patient counseling on risks and benefits.
- Minimal effective estrogen doses should be used; estrogen-only HRT is for hysterectomized women.
- Regular mammography, potential ultrasound for increased density, and annual HRT reviews with planned pauses are recommended. Breast surveillance should continue post-HRT.