Is Hormone Replacement Therapy Safe in Women With a BRCA Mutation?

Birrer, Nicole; Chinchilla, Carolina; Carmen, Marcela del; Dizon, Don S.

doi:10.1097/coc.0000000000000269

Cited by 32 publications

(24 citation statements)

References 14 publications

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“…In women who have retained their uterus, progesterone must be combined with estrogen for HRT to prevent stimulation of the endometrial lining and endometrial neoplasia. This presents a challenge to caregivers, as data from the Women's Health Initiative showed a significant increased risk of BC from the estrogen‐progesterone combination of Prempro compared with placebo and also compared with estrogen alone in postmenopausal women with no prior history of BC (HR = 1.28; 95% CI 1.11–1.48) . Still, the existing, if limited, data available from observational studies conducted specifically in m BRCA carriers suggest that HRT is safe following rrBSO and does not negate its protective benefit against BC .…”

Section: Morbidity Associated With Rrbsomentioning

confidence: 99%

“…The mainstay of OC prevention in these patients, riskreducing bilateral salpingo-oophorectomy (rrBSO), is recommended at the age of [35][36][37][38][39][40] or after completion of childbearing [7]. Although proven to be an effective strategy, the induction of premature menopause and lifelong health risks owing to estrogen deficiency are significant [8].…”

Section: Introductionmentioning

confidence: 99%

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Risk-Reducing Strategies for Ovarian Cancer in BRCA Mutation Carriers: A Balancing Act

Tschernichovsky

Goodman

2017

The Oncologist

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Objective. The objective of this study was to review the role of bilateral salpingo-oophorectomy in BRCA mutation (mBRCA) carriers and alternative interventions in risk reduction of ovarian cancer (OC). Materials and Methods. A systematic review using PubMed, MEDLINE, EMBASE, and the Cochrane library was conducted to identify studies of different strategies to prevent OC in mBRCA carriers, including bilateral salpingo-oophorectomy, prophylactic salpingectomy with delayed oophorectomy, intensive surveillance, and chemoprevention. Results. Risk-reducing bilateral salpingo-oophorectomy is an effective intervention, but its associated morbidity is substantial and seems to curtail uptake rates among the target population. Although there is much interest and a strong theoretical basis for salpingectomy with delayed oophorectomy, data on its clinical application are scarce with regard to screening, the use of an algorithmic protocol has recently shown favorable albeit indefinite results in average-risk postmenopausal women. Its incorporation into studies focused on high-risk women might help solidify a future role for screening as a bridge to surgery. The use of oral contraceptives for chemoprevention is well supported by epidemiologic studies. However, there is a lack of evidence for advocating any of the other agents proposed for this purpose, including nonsteroidal anti-inflammatory drugs, vitamin D, and retinoids. Conclusion. Further studies are needed before salpingectomy with delayed oophorectomy or intensive surveillance can be offered as acceptable, less morbid alternatives to upfront oophorectomy for mBRCA carriers. The Oncologist 2017;22:450-459 Implications for Practice: Risk-reducing bilateral salpingo-oophorectomy is currently the most effective method for reducing the risk of ovarian cancer in BRCA mutation (mBRCA) carriers. Unfortunately, it is associated with significant short-and long-term morbidity, stemming from reduced circulating estrogen. In recent years, much research has been devoted to evaluating less morbid alternatives, especially multimodal cancer screening and prophylactic salpingectomy with delayed oophorectomy. This review describes the present state of the art, with the aim of informing the counseling provided to mBRCA carriers on this complicated issue and encouraging additional research to facilitate the incorporation of such alternatives into routine practice.

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Section: Morbidity Associated With Rrbsomentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk-Reducing Strategies for Ovarian Cancer in BRCA Mutation Carriers: A Balancing Act

Tschernichovsky

Goodman

2017

The Oncologist

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“…Thus far, no RCTs have been conducted to address this issue. One recent systematic literature review 71 assessed the safety of hormone therapy in RRSO patients with BRCA mutations and found that women were likely to benefit symptomatically from hormone therapy and did not have an increased risk of breast cancer, but there was insufficient evidence regarding ovarian cancer risk. Additional studies are needed to assess ovarian cancer risk and outcomes of risk-reducing procedures in patients carrying Lynch syndrome mutations.…”

Section: Diagnosis and Preventionmentioning

confidence: 99%

Recent Advances in Understanding, Diagnosing, and Treating Ovarian Cancer

Mills

Fuh

2017

F1000Res

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“…This intervention can also prevent breast cancer in premenopausal women with BRCA2 mutations, although not those with BRCA1 mutations [43]. Premenopausal women with BRCA1 or BRCA2 mutations or with less frequent gene mutations, without prior breast cancer, undergoing oophorectomy should be advised to take menopausal hormone therapy (MHT) until the average age of natural menopause, since it does not appear to increase the risk of breast cancer [44][45][46]. A meta-analysis indicates that in these women and among those undergoing prophylactic salpingo-oophorectomy before the age of 40, MHT should be individualized and closely monitored [46].…”

Section: Brca1 and Brca2 Gene Mutationsmentioning

confidence: 99%

Interventions to reduce the risk of ovarian and fallopian tube cancer: A European Menopause and Andropause Society Position Statement

Pérez‐López

Ceaușu

Depypere³

et al. 2017

Maturitas

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In women with a genetic predisposition to ovarian cancer, salpingo-oophorectomy reduces the risk of ovarian malignancy, and to a lesser degree of breast cancer. Opportunistic bilateral salpingo-oophorectomy and bilateral salpingectomy may also prevent epithelial ovarian cancer. In premenopausal women, bilateral salpingectomy should be preferred to tubal ligation, and be performed when hysterectomy is carried out for benign uterine disease. Hysterectomy and the use of combined oral contraceptives and non-steroid anti-inflammatory drugs are also recognized to reduce the risk of ovarian cancer, as do the prevention of obesity and smoking cessation.

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Is Hormone Replacement Therapy Safe in Women With a BRCA Mutation?

Cited by 32 publications

References 14 publications

Risk-Reducing Strategies for Ovarian Cancer in BRCA Mutation Carriers: A Balancing Act

Risk-Reducing Strategies for Ovarian Cancer in BRCA Mutation Carriers: A Balancing Act

Recent Advances in Understanding, Diagnosing, and Treating Ovarian Cancer

Interventions to reduce the risk of ovarian and fallopian tube cancer: A European Menopause and Andropause Society Position Statement

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