Estrogen replacement therapy in women at increased risk for breast cancer

The topic of estrogen replacement (ERT) after the onset of menopause remains controversial and charged with considerable emotion within both the medical community and the lay public. This is especially true for women at increased risk for breast cancer as well as those who reach menopause after the diagnosis of this disease. ERT clearly protects postmenopausal women from the morbidity and mortality of cardiovascular disease and osteoporosis, and it alleviates vasomotor and genitourinary symptoms. However, there remains uncertainty whether and for which subgroups of women these benefits may be offset by a potential increased risk for breast cancer. With screening programs, breast cancer is being diagnosed at an earlier stage: with improved therapy, survival rates are improving. Adjuvant chemotherapy is increasingly incorporated in the treatment program of localized disease and accelerates the arrival of menopause. Thus, more and younger women with excellent survival prognosis will develop early menopause after treatment for early breast cancer. For these women, the decision regarding ERT is likely to affect the quality and quantity of their life for several decades. It is important to weigh the relative risks and benefits of ERT for each individual woman in order to develop a meaningful health maintenance plan.