[Hormone replacement therapy in menopausal women previously treated for breast cancer]

Is it possible to give a hormonal replacement therapy to a post-menopausal woman with a past history of breast cancer? As estrogens exert a proliferative effect on mammary cells, it remains a controversial issue. Only few studies have been conducted, generally uncontrolled, and involving only a small number of women given short-duration treatment. The endocrinologic arguments are discussed here. Hormone replacement therapy must be replaced in a general discussion on the potential risks for the breast and uterus, and the beneficial effect on coronary heart disease, osteoporosis, and quality of life. The risks and benefits must be weighted for each woman. The circumstances of prescription of hormone replacement therapy, and of the antiestrogen tamoxifen, which has proven a beneficial effect as adjuvant therapy for the menopausal women with a early breast cancer, must be discussed. Some physicians propose a prospective clinical trial to give an answer. Another way could be improvement of our knowledge about the prognostic factors of breast cancer, and better identification of possible "hormonal independance".