Management of menopausal symptoms in the cancer patient.
In the decades since hormone replacement therapy (HRT) was introduced, there has never been more controversy surrounding it than at present. Physicians and patients are faced with many questions regarding risk and few definitive answers. This article will discuss the current health benefits associated with hormone replacement, including its beneficial effects on the cardiovascular system, osteoporosis, vasomotor symptoms, colon cancer risk, and Alzheimer's disease. Epidemiologic evidence suggesting an association between HRT, estrogen in particular, and breast cancer will also be discussed. Currently, there is no definitive evidence of a link between HRT and breast cancer risk, particularly with short-term use. Yet, only about 15% of women who would benefit from such therapy actually use it. This is due, in part, to concerns regarding breast cancer risk. For the breast cancer survivor, the current dictum is that estrogen replacement is contraindicated. For these patients and those who choose not to start HRT, the list of adequate, currently available alternatives for the many menopausal symptoms is still insufficient. Because of the known beneficial effects of HRT, its extension to patients with a history of hormone-dependent cancer may be indicated. However, randomized, controlled trials must be performed to assess the potential risks in these patients.
Castiel
M
M
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
D000328:Adult; D000544:Alzheimer Disease / Q000209:etiology; D001943:Breast Neoplasms / Q000150:complications / Q000188:drug therapy*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D016889:Endometrial Neoplasms / Q000150:complications / Q000188:drug therapy; D005260:Female; D020249:Hormone Replacement Therapy / Q000009:adverse effects; D006801:Humans; D008593:Menopause; D008875:Middle Aged; D010024:Osteoporosis / Q000517:prevention & control; D012307:Risk Factors