Menopausal hormone therapy (HT) in patients with breast cancer.
OBJECTIVE
To assess the effect of menopausal hormone therapy (HT) on reoccurrence, cancer-related mortality, and overall mortality after a diagnosis of breast cancer.


METHODS
We performed a quantitative review of all studies reporting experience with menopausal HT for symptomatic use after a diagnosis of breast cancer. Rates of reoccurrence, cancer-related mortality, and overall mortality were calculated in this entire group. A subgroup analysis was performed in studies using a control population to assess the odds ratio of cancer reoccurrence and mortality in hormone users versus non-users.


RESULTS
Fifteen studies encompassing 1416 breast cancer survivors using HT were identified. Seven studies included a control group comprised of 1998 patients. Among the 1416 HT users, reoccurrence was noted in 10.0% (95% CI: 8.4-11.6%). Cancer-related mortality occurred at a rate of 2.6% (95% CI: 1.8-3.7%), while overall mortality was 4.5% (95% CI: 3.4-5.8%). Compared to non-users, patients using HT had a decreased chance of reoccurrence and cancer-related mortality with combined odds ratio of 0.5 (95% CI: 0.2-0.7) and 0.3 (95% CI: 0.0-0.6), respectively.


CONCLUSIONS
In our review, menopausal HT use in breast cancer survivors was not associated with increased cancer reoccurrence, cancer-related mortality or total mortality. Despite conflicting opinions on this issue, it is important for primary care physicians to feel comfortable medically managing the increasing number of breast cancer survivors. In the subset of women with severe menopausal symptoms, HT options should be reviewed if non-hormonal methods are ineffective. Future trials should focus on better ways to identify breast cancer survivors who may safely benefit from HT versus those who have a substantial risk of reoccurrence with HT use.
Batur
Pelin
P
Department of Internal Medicine, Section of Women's Health Cleveland Clinic Foundation, Crown Centre II, Independence, OH 44131, USA. baturp@ccf.org
Blixen
Carol E
CE
Moore
Halle C F
HC
Thacker
Holly L
HL
Xu
Meng
M
D000328:Adult; D001943:Breast Neoplasms / Q000139:chemically induced / Q000401:mortality*; D015914:Estrogen Replacement Therapy / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D019584:Hot Flashes / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008593:Menopause / Q000187:drug effects; D008594:Menopause, Premature / Q000187:drug effects; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000139:chemically induced* / Q000401:mortality; D009376:Neoplasms, Hormone-Dependent / Q000139:chemically induced / Q000401:mortality; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome