Nonhormonal alternatives for the management of early menopause in younger women with breast cancer.
Current medical practice recommends the use of alternatives to estrogen-replacement therapy for the treatment of menopausal sequelae in younger women with breast cancer, although this clinical recommendation is undergoing reappraisal. Until prospective randomized studies addressing hormone use in this population are available, estrogen use in breast cancer patients will remain controversial. Because estrogen-replacement therapy is not the standard of practice and there is limited information available on nonestrogen therapies, women with breast cancer who are menopausal may not be prescribed or counseled about nonestrogen options. The efficacy, safety, and extent of use of most nonestrogen treatment modalities (other hormonal preparations, nonhormonal drugs, homeopathic preparations, and non-drug treatments) are not well documented and, unlike estrogen, many are selective in their benefit and do not share estrogen's universal impact. The use of several nonestrogen approaches for the prevention and treatment of osteoporosis has been promising. Traditional recommendations to maintain skeletal integrity, such as weight-bearing exercise; a diet rich in calcium and limited in caffeine, alcohol, and protein; avoidance of smoking; and measures to minimize trauma have been expanded to include the use or investigation of drugs (either alone or in combination). These drugs include progestins, vitamin D metabolites, injectable and intranasal synthetic salmon calcitonin, bisphosphonates, sodium fluoride, parathyroid hormone, growth factors, tamoxifen, etc. Strict control of the known risk factors, such as smoking, dyslipidemia, and hypertension as well as exercise, weight control, and the use of tamoxifen, are employed for the prevention and treatment of cardiovascular complications.(ABSTRACT TRUNCATED AT 250 WORDS)
Bachmann
G A
GA
Department of Obstetrics and Gynecology, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick 08903.
D000328:Adult; D000367:Age Factors; D000970:Antineoplastic Agents / Q000009:adverse effects; D001284:Atrophy; D001685:Biological Factors / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000628:therapy; D002116:Calcitonin / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000517:prevention & control* / Q000628:therapy; D000529:Complementary Therapies; D005260:Female; D005483:Flushing / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D006801:Humans; D008019:Life Style; D008594:Menopause, Premature / Q000523:psychology; D001523:Mental Disorders / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D010052:Ovariectomy / Q000009:adverse effects; D010936:Plant Extracts / Q000009:adverse effects / Q000627:therapeutic use; D016649:Primary Ovarian Insufficiency / Q000139:chemically induced / Q000628:therapy; D011372:Progestins / Q000627:therapeutic use; D012307:Risk Factors; D017741:Survivors; D013629:Tamoxifen / Q000627:therapeutic use; D014621:Vagina / Q000473:pathology
D000970:Antineoplastic Agents; D001685:Biological Factors; D002317:Cardiovascular Agents; D010936:Plant Extracts; D011372:Progestins; D013629:Tamoxifen; D002116:Calcitonin