Estrogen replacement therapy in survivors of breast cancer: a risk-benefit assessment

The use of hormone replacement therapy (HRT) after breast cancer is controversial. For a minority of such women, menopausal symptoms such as hot flushes can be so severe as to compromise quality of life. Moderate doses of progestogens alone are an effective therapy for hot flushes in around two-thirds of patients and poorly absorbed topical estrogens are well tolerated and effective for vaginal dryness. However, for a small number of women, the only effective therapy for hot flushes is estrogen replacement. Women with early stage breast cancer are unlikely to die from this disease and will be more likely to be affected by age-related diseases such as heart disease, strokes and osteoporotic fractures. These women may also benefit from estrogen replacement. Prospective trials are currently under way to determine the safety of HRT after breast cancer.