Estrogen replacement therapy in breast cancer survivors: a matched-controlled series.
OBJECTIVE
We prospectively administered estrogen replacement therapy (ERT) to control estrogen deficiency symptoms in breast cancer survivors as part of our clinical practice. We report the consequences of ERT compared with a historical matched-control group.


METHODS
Two hundred seventy-seven disease-free survivors received ERT. Controls were matched for exact stage, a recurrence-free period similar to the period to ERT initiation in the ERT group, approximate age, and duration of follow-up. The mean time from breast cancer diagnosis to initiation of ERT was 3.61 (+/- 0.25) years, with a median of 1.88 years. The mean duration of ERT was 3.7 (+/- 3.01) years, with a median of 3.05 years.


RESULTS
Hot flashes were relieved in 206 of 223 women (92%), dyspareunia/vaginal dryness in 149 of 167 women (89%), and reactive depression/anxiety/mood change in 111 of 126 women (88%). Univariate analysis demonstrated no statistical differences between the groups for age, stage, pathology at diagnosis, progesterone receptor status, local therapy, breast at risk, prior chemotherapy, and duration of follow-up. The ERT group was more likely to be estrogen receptor negative (P = 0.01), to have received prior ERT (P < 0.001), and to have received no adjuvant tamoxifen (P < 0.001). There was no significant difference between the ERT and control groups in ipsilateral primary/recurrence (5/155 v 5/143; P = 0.85), contralateral breast cancers (10/258 v 9/260; P = 0.99), or systemic metastasis (8/277 v 15/277; P = 0.13). Noncause-specific deaths in the control group numbered 15 (of 277), and in the ERT group, 7 (of 277) (P = 0.03). Overall survival favored the ERT group (P = 0.02).


CONCLUSIONS
In these selected patients, ERT relieved estrogen deficiency symptoms and did not increase the rate or time to an ipsilateral recurrence/new primary, contralateral new primary, local-regional recurrence, or systemic metastases.
Decker
David A
DA
Department of Medicine, William Beaumont Hospital, Royal Oak-Troy, MI 48073, USA. ddecker@beaumont.edu
Pettinga
Jane E
JE
VanderVelde
Nancy
N
Huang
Raywin R
RR
Kestin
Larry
L
Burdakin
John H
JH
D001943:Breast Neoplasms / Q000628:therapy*; D016022:Case-Control Studies; D004414:Dyspareunia / Q000188:drug therapy; D015914:Estrogen Replacement Therapy; D004967:Estrogens / Q000627:therapeutic use; D004970:Estrone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D019584:Hot Flashes / Q000188:drug therapy; D006801:Humans; D019964:Mood Disorders / Q000188:drug therapy; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D011446:Prospective Studies; D016019:Survival Analysis; D017741:Survivors; D014623:Vaginal Diseases / Q000188:drug therapy
D004967:Estrogens; D004970:Estrone; C009927:estropipate