January 8, 2002
Hormone replacement therapy and cancer: Balancing safety and quality
of life
Cancer survivors
Dirk Iglehart, MD
In general, women who have had breast cancer do not take HRT. They may refrain to avoid a recurrence of the cancer or the development of a new tumor in the breast. However, there are exceptions. For a breast cancer survivor, the decision is often based on what kind of malignancy she had. About 70 percent of breast tumors have estrogen receptors on their cells' surfaces, which means the cancers are sensitive to estrogen in the body. Since estrogen probably contributes to the growth of these cancers, giving a woman estrogen in HRT could increase the risk she faces.
"HRT is less of an option for these women," says J. Dirk Iglehart, MD, director of the Women's Cancers Pro-gram. "However, women who have had a low-risk, low-grade type of breast cancer with a high cure rate may indeed be candidates for HRT."
Some small studies looking at HRT and breast cancer survivors have yielded reassuring results. The key is to individualize the decision. "First I find out if the patient is having symptoms," he says. "If she is, I translate statistics: Does HRT represent a significant health risk to you as an individual? Together we look at her risk for cardiovascular disease, osteoporosis, and other types of cancer, as well as breast cancer. If the risks are minimal and she does not begin to feel better as menopause progresses, I am comfortable starting her on HRT for the short term." Dr. Iglehart is even willing to prescribe HRT in the short term for certain women who have had an estrogen-sensitive tumor, although he admits that not all experts would agree.
Next page: Promise for the future
