Estrogen Replacement Therapy After Localized Breast Cancer: Clinical Outcome of 319 Women Followed Prospectively

Vassilopoulou‐Sellin, Rena; Asmar, Lina; Hortobágyi, Gabriel N.; Klein, Mary Jean; McNeese, Marsha D.; Singletary, S. Eva; Theriault, Richard L.

doi:10.1200/jco.1999.17.5.1482

Cited by 99 publications

(30 citation statements)

References 20 publications

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“…The potential use of HRT in such patients is controversial, although recent reports have failed to confirm any increased risk of recurrence in women using HRT for breast cancer treatment, whereas the benefits in the quality of life reported were significant (Vassilopoulou-Sellin et al 1999, O'Meara et al 2001. However, existing clinical data do not yet suffice to evaluate the efficacy of this strategy (Cobleigh et al 1994, Shapiro & Recht 2001 and further randomized studies are needed to reassess the issue of HRT in women with breast cancer.…”

Section: Primary Menopause and Hrt In Women With Breast Cancermentioning

confidence: 97%

Effects of estrogen deprivation due to breast cancer treatment

Angelopoulos¹,

Barbounis²,

Livadas³

et al. 2004

Endocr Relat Cancer

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Breast cancer is one of the main life-threatening diseases that a woman may have to face during her lifetime. The increasing incidence of breast neoplasia reported over the last few decades has led to widespread screening of women resulting in early diagnosis. One common but challenging question for most doctors, after the surgical excision of the lesion, is determination of the ideal adjuvant therapy for their patients for the achievement of maximum life expectancy with the best quality of life.Since the beginning of the last century, the knowledge that breast cancer arises from hormoneresponsive tissues has long made use of hormone-blocking agents in the beneficial treatment of breast neoplasia. The discovery of new molecules with endocrine actions has rendered the use of adjuvant therapy in a tailor-made pattern too complicated, as these agents have a different mode of action, different adverse effects and probably different indications.The aim of the present review is to clarify these issues, analyzing the mechanism of action of available drugs and their actions on specific areas of uncertainty: cognitive function, cardiovascular system, urogenital tract, bone metabolism, weight gain, hot flushes and premature menopause. Regarding the efficacy of adjuvant therapy, there has been particular focus on the multiple hormonal-induced consequences of each regimen in order to provide the clinician with the available data for choosing the ideal therapy for the patient.

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Section: Primary Menopause and Hrt In Women With Breast Cancermentioning

confidence: 97%

Effects of estrogen deprivation due to breast cancer treatment

Angelopoulos¹,

Barbounis²,

Livadas³

et al. 2004

Endocr Relat Cancer

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show abstract

“…Some authors have proposed the prescription of HRT after breast cancer (Vassilopoulo-Sellin et al 1999), but these prescriptions remain limited to a few experimental studies; most physicians continue to avoid HRT in breast cancer survivors because of concern regarding the promotion of growth and dissemination of occult malignant cells while on HRT. Besides these treatments, which are prescribed under medical control, soy phytoestrogens derived from plants are being promoted as the 'natural alternative' to HRT, and have been available without restriction as nutritional supplements for several years.…”

Section: Introductionmentioning

confidence: 99%

Phytoestrogens after breast cancer.

This

Rochefordière²,

Clough³

et al. 2001

Endocrine-Related Cancer

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The current extension of the indications for adjuvant chemotherapy, which predisposes to early menopause, and the media coverage of the benefits of hormone replacement therapy (HRT) have led patients with a history of breast cancer to seek treatments for estrogen deprivation. In breast cancer survivors, most physicians avoid HRT because of concern regarding the potential promotion of growth of occult malignant cells by estrogens, due to the estrogen dependence of breast cancer. Soy phytoestrogens are being promoted as the 'natural alternative' to HRT and have been available without restrictions for several years as nutritional supplements. In this paper, data on the complex mammary effects of phytoestrogens in epidemiological studies, in in vitro studies, as well as in in vivo studies on animal carcinogenesis are reviewed. The potential benefits and risks of phytoestrogens are analyzed, and the prescription of phytoestrogens to postmenopausal women after breast cancer and the coprescription with the anti-estrogen tamoxifen are discussed. The absence of controlled trials and technical checking of extraction and titration in these preparations on 'free sale' raise a new problem in terms of public health and justify close reasoning and a cautious attitude of physicians, as well as straight information given to women, especially after breast cancer.

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“…Available data indicate that HRT does not seem to adversely affect breast cancer outcome [7][8][9][10] . Among 319 women with breast cancer followed prospectively, there was only one breast cancer event in the HRT group against 20 in the control group 10 .…”

Section: Discussionmentioning

confidence: 99%

“…Hormone replacement therapy (HRT) with estrogen has been used for many decades for managing menopausal symptoms and urogenital dysfunction as well as for reducing the morbidity and mortality related to osteoporosis and cardiovascular disease [2][3][4][5][6] . Despite the fact that HRT has demonstrably improved the quality of life in healthy postmenopausal women; few observational studies [7][8][9][10] have approached this therapy in breast cancer treated patients, and none of them have observed either increased disease recurrence or mortality.…”

Section: Introductionmentioning

confidence: 99%

Hormone replacement therapy and the risk of breast cancer: assessment of therapy acceptance in a cohort of previously treated breast cancer patients

Anelli¹,

Gimenez²,

Rocha³

et al. 2003

Rev. Hosp. Clin.

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INTRODUCTION: In the postmenopausal period, an average of 25% of women will present symptomatic ovarian failure requiring hormonal replacement therapy. Estrogen can relieve vasomotor symptoms. Hormonal replacement therapy is generally not recommended for breast cancer patients due to the potential risk of tumor recurrence. To answer the questions about the safety of hormonal replacement therapy in this subgroup of women, it is necessary to establish the acceptance of treatment. METHODS: Between September 1998 and February 2001, a cohort of 216 breast cancer patients were asked to complete a questionnaire. All patients had completed their treatment and were informed about survival rates after breast cancer and hormonal replacement therapy. RESULTS: Among the 216 patients, 134 (62%) would refuse hormonal replacement therapy. A hundred patients were afraid of relapse (74.6%). Adjuvant tamoxifen therapy was the only statistically significant variable (70.3% versus 29.7% p=0.003). Understanding clinical stage (p= 0.045) and type of medical assistance (private versus public , p=0.033) also seemed to influence the decision. Early stage disease (p= 0.22), type of surgical procedure (radical versus conservative, p=0.67), adjuvant chemotherapy (p=0.082) or marital status (p=0.98 ) were not statistically significant in decision making. Several patients submitted to adjuvant chemotherapy (41.6%) would accept hormonal replacement therapy under medical supervision, as did most of advanced clinical stage patients (58.3%; p=0.022). CONCLUSION: There is a high level of rejection for hormonal replacement therapy among breast cancer patients when current data on tumor cure rates, and potential risks of estrogen use is available. Adverse effects of tamoxifen in the adjuvant setting may be the reason for refusal of hormonal replacement therapy .

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Estrogen Replacement Therapy After Localized Breast Cancer: Clinical Outcome of 319 Women Followed Prospectively

Abstract: ERT does not seem to increase breast cancer events in this subset of patients previously treated for localized breast cancer. Results of randomized trials are needed before any changes in current standards of care can be proposed.

Cited by 99 publications

References 20 publications

Effects of estrogen deprivation due to breast cancer treatment

Effects of estrogen deprivation due to breast cancer treatment

Phytoestrogens after breast cancer.

Hormone replacement therapy and the risk of breast cancer: assessment of therapy acceptance in a cohort of previously treated breast cancer patients

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