Hormone replacement therapy and breast cancer morbidity, mortality and recurrence

The effects of short-term and long-term HRT (in its various forms, unopposed oestrogens, sequentially combined HRT and continuous combined HRT) on the female breast are reviewed. The question is addressed whether HRT will increase the risk of breast cancer as well as the risk of dying from breast cancer in healthy women, and whether or not women who already run an increased risk on the basis of a positive family history, use of DES during pregnancy or because of the presence of premalignant epithelial abnormalities in the breast, increase their risk for breast cancer further. The risks of HRT and the options for HRT in patients who have a history of breast cancer are discussed and alternative treatment modalities for climacteric complaints (e.g. clonidine, paced-respiration) or for preventive HRT (e.g. tamoxifen, tibolone) are reviewed.