Hormone replacement therapy in cancer survivors: a con opinion

In patients with hormonally sensitive tumors, estrogen replacement therapy carries a theoretical risk of stimulating recurrent disease as well as contributing to an increased risk of other hormonally related cancers. In women with hormone-related cancers, it is unknown if their inherently increased risk for other related cancers can be further increased by the administration of hormones. In genetically susceptible animal models, hormones have been shown to promote growth of hormonally sensitive cancers. The uncertainty and potential risk of hormone replacement therapy demonstrates the need for randomized, prospective trials to provide women with a reasonable basis for therapeutic alternatives. The most prudent approach with this population is to consider alternative treatments until the ongoing, randomized clinical trials have been evaluated with adequate longterm follow-up. Until such time, nonhormonal alternatives to manage symptomatic patients should be employed. It is incumbent on physicians to educate themselves and become adept in their use. Diet and exercise will have to be an essential component of the counseling provided to patients following cancer therapy.