Hormone replacement therapy after treatment for cervical cancer: Are we adhering to standard of care?

Rauh, Lisa A.; Pannone, Aaron; Cantrell, Leigh A.

doi:10.1016/j.ygyno.2017.09.009

Cited by 19 publications

(11 citation statements)

References 20 publications

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“…Nevertheless, one study in Germany showed that fewer than half of all women diagnosed with iatrogenic menopause after cervical cancer received counselling and/or a prescription for HRT. These results reflect the need for clearer guidelines on HRT 27 ( Table 1 ).…”

Section: Hrt After Cervical Cancersupporting

confidence: 57%

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Hormone Replacement Therapy After Gynaecological Malignancies: a Review Article

Sourouni

Kiesel

2021

Geburtshilfe Frauenheilkd

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Rapid advances in oncology have led to an increased survival rate in cancer patients, who live long enough to reach the natural age of menopause or experience the end of gonadal function as a side effect of oncological treatment. Survivors after gynaecological malignancies are a major challenge as these diseases are hormone-dependent and hormone replacement therapy (HRT) possibly increases the risk of recurrence. This article is based on a selective literature search for relevant studies and guidelines regarding HRT after gynaecological malignancies and provides a broad overview of current research. The data for assessing the oncological safety of HRT after gynaecological malignancy are insufficient overall. According to current knowledge, HRT is fundamentally contraindicated after breast and endometrial cancer. After ovarian cancer, HRT can be used after assessment of the risks and benefits, while there is usually no contraindication to HRT after vulvar, vaginal or cervical cancer.

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Section: Hrt After Cervical Cancersupporting

confidence: 57%

“…Dennoch zeigte eine Studie innerhalb Deutschlands, dass weniger als die Hälfte aller Frauen nach der Diagnose einer iatrogenen Menopause nach Zervixkarzinom eine Beratung und/oder ein Rezept für eine HRT erhielten. Diese Ergebnisse unterstreichen die Notwendigkeit klarerer Richtlinien zur HRT 27 ( Tab. 1 ).…”

Section: Hrt Nach Zervixkarzinomunclassified

Hormone Replacement Therapy After Gynaecological Malignancies: a Review Article

Sourouni

Kiesel

2021

Geburtshilfe Frauenheilkd

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“…This is actually better than expected since previous studies have shown that fewer than half of all women diagnosed with an IM after treatment for cervical cancer receive counselling and/or a prescription for HRT. 10 This is probably a reflection of the limited evidence available and the clarity of guidelines on HRT during survivorship. During the study period, the use of HRT following treatment for cervical cancer was not incorporated into any of the departmental standard operating procedures and, as such, its recommendation (or otherwise) was purely at the discretion of the clinician conducting the follow-up appointment.…”

Section: Discussionmentioning

confidence: 99%

Safety of hormone replacement therapy in women with a history of cervical adenocarcinoma

et al. 2021

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Objectives Studies investigating the safety of hormone replacement therapy in cervical cancer have predominantly included patients with squamous disease. Pathological studies have identified estrogen receptor positivity in cervical adenocarcinomas. A recent small case-control study suggested a trend towards reduced survival with hormone replacement therapy in cervical adenocarcinomas. Our objective was to determine if hormone replacement therapy use in patients treated for cervical adenocarcinomas is detrimental to survival. Study design A retrospective review of all women under the age of 50 with stage 1B-2B cervical adenocarcinomas diagnosed between 1 November 2000 and 24 September 2019. Women were categorised into three groups: ovaries conserved (OVCON); or iatrogenic menopause with (IM-HRT) or without (IM-NOHRT) hormone replacement therapy. Hormone replacement therapy use was defined on an intention to treat basis. Statistical analysis was performed using Kaplan-Meier and Cox proportional hazards methods. Main outcome measures Overall (OS), disease specific (DSS) and progression free (PFS) survival. Results A total of 58 women (mean age 38.5 ± 6.6) were included in the study of whom 25 (43.1%) had OVCON, 20 (34.4%) had IM-HRT and 13 (22.4%) had IM-NOHRT. No menopause-associated deaths occurred. Although five-year DSS was 73% in IM-NOHRT compared to 95% in IM-HRT and 95% in OVCON, these differences were not statistically significant. Five-year PFS was 68% in IM-NOHRT compared to 90% in IM-HRT and 81% in OVCON but again, these differences were not statistically significant. Conclusion In this small study, hormone replacement therapy does not appear to be detrimental to survival in cervical adenocarcinomas. There is a trend towards improved survival with hormone replacement therapy. Larger studies are required to substantiate these findings.

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“…However, estrogen receptors are frequently (39%) expressed in cervical adenocarcinomas, even though their expression does not correlate with clinicopathologic parameters and does not influence overall and disease-free survival 10 61 62. In the limited studies available, no significant difference in recurrence rate or survival63–66 has been linked with menopausal hormone therapy use after treatment for cervical squamous cell carcinomas. In women who have been treated with radiotherapy, rather than hysterectomy, for cervical cancer, opposed estrogen therapy to prevent stimulation of residual endometrium should be used 67…”

Section: Introductionmentioning

confidence: 99%

European Menopause and Andropause Society (EMAS) and International Gynecologic Cancer Society (IGCS) position statement on managing the menopause after gynecological cancer: focus on menopausal symptoms and osteoporosis

Rees

Angioli

Coleman

et al. 2020

Int J Gynecol Cancer

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Worldwide, it is estimated that about 1.3 million new gynecological cancer cases are diagnosed each year. For 2018, the predicted annual totals were cervix uteri 569 847, corpus uteri 382 069, ovary 295 414, vulva 44 235, and vagina 17 600. Treatments include hysterectomy with or without bilateral salpingo-oophorectomy, radiotherapy, and chemotherapy. These can result in loss of ovarian function and, in women under the age of 45 years, early menopause. The aim of this position statement is to set out an individualized approach to the management, with or without menopausal hormone therapy, of menopausal symptoms and the prevention and treatment of osteoporosis in women with gynecological cancer. Our methods comprised a literature review and consensus of expert opinion. The limited data suggest that women with low-grade, early-stage endometrial cancer may consider systemic or topical estrogens. However, menopausal hormone therapy may stimulate tumor growth in patients with more advanced disease, and non-hormonal approaches are recommended. Uterine sarcomas may be hormone dependent, and therefore estrogen and progesterone receptor testing should be undertaken to guide decisions as to whether menopausal hormone therapy or non-hormonal strategies should be used. The limited evidence available suggests that menopausal hormone therapy, either systemic or topical, does not appear to be associated with harm and does not decrease overall or disease-free survival in women with non-serous epithelial ovarian cancer and germ cell tumors. Caution is required with both systemic and topical menopausal hormone therapy in women with serous and granulosa cell tumors because of their hormone dependence, and non-hormonal options are recommended as initial therapy. There is no evidence to contraindicate the use of systemic or topical menopausal hormone therapy by women with cervical, vaginal, or vulvar cancer, as these tumors are not considered to be hormone dependent.

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Hormone replacement therapy after treatment for cervical cancer: Are we adhering to standard of care?

Cited by 19 publications

References 20 publications

Hormone Replacement Therapy After Gynaecological Malignancies: a Review Article

Hormone Replacement Therapy After Gynaecological Malignancies: a Review Article

Safety of hormone replacement therapy in women with a history of cervical adenocarcinoma

European Menopause and Andropause Society (EMAS) and International Gynecologic Cancer Society (IGCS) position statement on managing the menopause after gynecological cancer: focus on menopausal symptoms and osteoporosis

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