[Hormone replacement therapy after treatment of breast carcinoma]

A correct Hormone Replacement Therapy (HRT) guarantees a successful treatment of subjective symptoms of oestrogen deficiency and an efficient prevention of postmenopausal osteoporosis, of cardiovascular diseases and of M. Alzheimer. In non-substituted postmenopausal women, the risk to die from a myocardial infarction is ten times higher than the risk to die from a carcinoma of the breast or the consequences of a fracture of the femoral neck. In spite of this observation, the acceptance is still insufficient because of an unjustified fear of hormone-induced carcinomas. The incidence of a carcinoma of the breast is not higher in women profiting of a HRT by a correct combination of an oestrogen and a progestogen administered up to 5 years than in untreated controls. Although some but not all authors suspect a slight increase of the relative risk of a carcinoma of the breast to approximately 1.5 after > or = 10 years of HRT, the overall mortality of substituted women is clearly inferior to the one of a non-substituted population. However, the final goal of HRT is not prolongation of life, but a better quality of life. Quality of life is often miserable in women treated for breast cancer. The final answer to the question if women after treatment of breast cancer should be allowed to profit of HRT is still open because formal evidence is missing. However, a woman should not be denied HRT if she lived two years without relapse since her primary cancer and if she does not belong to the subgroup where adjuvant treatment by tamoxifen is appropriate. In the future, selective oestrogen receptor modulators may be used in women after breast cancer.