REVIEW Hormone Replacement Therapy: An Increased Risk of Recurrence and Mortality for Breast Cancer Patients?

Historically, randomized controlled trials (RCTs) have shown an in-creased risk of recurrence and mortality among women who have used primarily oral HRT after breast cancer. However, many of these studies have had design flaws that may impact the findings. Numerous investi-gators have concluded that additional RCTs should be performed, but because of ethical issues and logistic challenges, large-scale RCTs are unlikely. Thus, the authors conducted an integrative review investigat-ing recurrence and mortality data among breast cancer survivors who have used hormone replacement therapy (HRT). They recommend a stepwise algorithm for treating vaginal symptoms in breast cancer sur-vivors: (1) start with nonhormonal treatments; (2) progress to a de-tailed discussion among patients and health-care professionals about the current known risks and benefits of vaginal estrogen; and (3) con-clude with mutual decision-making between health-care providers and patients regarding the use of vaginal estrogen treatment. J Adv Pract Oncol 2015;6:322–330 More than a quarter of a million cases of breast cancer are diagnosed each year in the Unit-ed States. Of these cases, 75 % are estrogen receptor (ER)–positive or progesterone receptor (PR)–positive (Esserman & Joe, 2013). The treat-ment regimen for receptor-positive breast cancer often includes endo-crine therapy, which places these women at an increased risk for vagi-nal dryness, dyspareunia, urogeni-tal atrophy, and sexual dysfunction. The gold standard of treatment for these symptoms is hormone replace-ment therapy (HRT); however, many health-care providers question the safety of HRT and its relationship to disease recurrence