title: Hormone replacement therapy and the risk of breast cancer: assessment of therapy acceptance in a cohort of previously treated breast cancer patients.
abstract: BACKGROUND
  In the postmenopausal period, an average of 25% of women will present symptomatic ovarian failure requiring hormonal replacement therapy. Estrogen can relieve vasomotor symptoms. Hormonal replacement therapy is generally not recommended for breast cancer patients due to the potential risk of tumor recurrence. To answer the questions about the safety of hormonal replacement therapy in this subgroup of women, it is necessary to establish the acceptance of treatment.
  
  
  METHODS
  Between September 1998 and February 2001, a cohort of 216 breast cancer patients were asked to complete a questionnaire. All patients had completed their treatment and were informed about survival rates after breast cancer and hormonal replacement therapy.
  
  
  RESULTS
  Among the 216 patients, 134 (62%) would refuse hormonal replacement therapy. A hundred patients were afraid of relapse (74.6%). Adjuvant tamoxifen therapy was the only statistically significant variable (70.3% versus 29.7% p=0.003). Understanding clinical stage (p= 0.045) and type of medical assistance (private versus public, p=0.033) also seemed to influence the decision. Early stage disease (p= 0.22), type of surgical procedure (radical versus conservative, p=0.67), adjuvant chemotherapy (p=0.082) or marital status (p=0.98 ) were not statistically significant in decision making. Several patients submitted to adjuvant chemotherapy (41.6%) would accept hormonal replacement therapy under medical supervision, as did most of advanced clinical stage patients (58.3%; p=0.022).
  
  
  CONCLUSIONS
  There is a high level of rejection for hormonal replacement therapy among breast cancer patients when current data on tumor cure rates, and potential risks of estrogen use is available. Adverse effects of tamoxifen in the adjuvant setting may be the reason for refusal of hormonal replacement therapy.
authors.affiliation: Department of Clinical Oncology, Câncer Hospital, Santo André, SP, Brasil.
authors.forename: Agnaldo
authors.initials: A
authors.lastname: Anelli
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Gimenez
authors.forename: Aline Porto
authors.initials: AP
authors.lastname: Rocha
authors.forename: Cíntia Mendonça
authors.initials: CM
authors.lastname: de Abreu
authors.forename: Helano Carioca
authors.initials: HC
authors.lastname: Freitas
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001943:Breast Neoplasms / Q000139:chemically induced* / Q000628:therapy; D015331:Cohort Studies; D015914:Estrogen Replacement Therapy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D009364:Neoplasm Recurrence, Local; D010342:Patient Acceptance of Health Care; D012307:Risk Factors; D020845:Selective Estrogen Receptor Modulators / Q000009:adverse effects / Q000627:therapeutic use; D013629:Tamoxifen / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D020845:Selective Estrogen Receptor Modulators; D013629:Tamoxifen