Hormone replacement therapy in cancer survivors.
OBJECTIVE
Thousands of women are treated each year for cancer; many of these are already in menopause, while other younger patients will go into early menopause due to surgery, or chemotherapy, or the need for radiotherapy to the pelvic region. In most cases the oncologist and the gynaecologist would advise these women against the use of HRT. The purpose of this paper is to review biological and clinical evidences in favour and against HRT use in the different tumours and to propose an algorithm that can help choosing the treatment for the single woman.


METHODS
We performed a systematic literature review through April 2002 concerning: (1) biological basis of hormonal modulation of tumour growth; (2) epidemiological data on the impact of HRT on different cancers risk in healthy women; (3) safety of HRT use in cancer survivors; (4) alternatives to HRT.


RESULTS
With the exception of meningioma, breast and endometrial cancer, there is no biological evidence that HRT may increase recurrence risk. In women with previous breast and endometrial cancer HRT is potentially hazardous on a biological basis, even if published data do not show any worsening of prognosis.


CONCLUSIONS
Even if a cautious approach to hormonal-dependent neoplasias is fully comprehensible and the available alternative treatment should be taken into greater consideration, the reticence to prescribe HRT in women previously treated for other non hormone-related tumours has neither a biological nor a clinical basis. An algorithm based on present knowledge is proposed.
Academic Department of Gynaecological Oncology, Institute for Cancer Research and Treatment (IRCC), University of Turin, Candiolo, Largo Turati 62, 10128 Torino, Italy.
Nicoletta
N
Biglia
Angelo
A
Gadducci
Riccardo
R
Ponzone
Riccardo
R
Roagna
Piero
P
Sismondi
D001943:Breast Neoplasms / Q000188:drug therapy; D003110:Colonic Neoplasms / Q000188:drug therapy; D016889:Endometrial Neoplasms / Q000188:drug therapy; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy; D008113:Liver Neoplasms / Q000188:drug therapy; D008175:Lung Neoplasms / Q000188:drug therapy; D008545:Melanoma / Q000188:drug therapy; D008579:Meningioma / Q000188:drug therapy; D008593:Menopause / Q000187:drug effects* / Q000378:metabolism; D009369:Neoplasms / Q000188:drug therapy*; D010051:Ovarian Neoplasms / Q000188:drug therapy; D012307:Risk Factors; D017741:Survivors; D013964:Thyroid Neoplasms / Q000188:drug therapy; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy; D014846:Vulvar Neoplasms / Q000188:drug therapy