Safety of systemic hormone replacement therapy in breast cancer survivors: a systematic review and meta-analysis

Poggio, F.; Mastro, Lucia Del; Bruzzone, Marco; Ceppi, Marcello; Razeti, Maria Grazia; Fregatti, Piero; Ruelle, Tommaso; Pronzato, P.; Massarotti, Claudia; Franzoi, Maria Alice; Lambertini, Matteo; Tagliamento, Marco

doi:10.1007/s10549-021-06436-9

Cited by 29 publications

(16 citation statements)

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“…With the exception of a 2-week controlled ovarian stimulation for oocyte or embryo cryopreservation before starting chemotherapy, 37 exposure to hormonal-based therapies may increase the risk of recurrence. 38 Thus, these therapies are contraindicated in women with breast cancer. Therefore, the ideal contraceptive methods in this cohort were nonhormonal approaches with good reliability and tolerability.…”

Section: Discussionmentioning

confidence: 99%

“…Specialized contraceptive counseling is also important to selecting the most appropriate and reliable method, a particularly sensitive issue among those with hormonally based tumors such as breast cancer. With the exception of a 2-week controlled ovarian stimulation for oocyte or embryo cryopreservation before starting chemotherapy, exposure to hormonal-based therapies may increase the risk of recurrence . Thus, these therapies are contraindicated in women with breast cancer.…”

Section: Discussionmentioning

confidence: 99%

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Contraceptive Use in Premenopausal Women With Early Breast Cancer

et al. 2022

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ImportanceAs life span has increased among patients with cancer, survivorship has become an important component of breast cancer care. Among survivorship concerns, adequate contraceptive counseling is needed for premenopausal patients who are not seeking to become pregnant.ObjectiveTo examine contraceptive use and chosen methods and to assess factors associated with contraceptive use over time in patients with early breast cancer.Design, Setting, and ParticipantsThe Cancer Toxicity (CANTO) study was a multicenter nationwide prospective cohort study that enrolled women diagnosed with stage I to stage III breast cancer in France between March 2012 and December 2017. This analysis included 2900 premenopausal women who were 50 years of age or younger at diagnosis. Data were analyzed from July 2020 to July 2022.ExposuresContraceptive use and method at diagnosis, shortly after the end of primary treatment (year 1), and during follow-up (year 2).Main Outcomes and MeasuresContraceptive use and methods were longitudinally evaluated at diagnosis, year 1, and year 2 after breast cancer diagnosis. Multivariable logistic regression models were used to assess the associations of clinical, socioeconomic, treatment, adverse effect, and patient-reported outcome variables with contraceptive use after diagnosis.ResultsA total of 2900 patients (mean [SD] age, 43.1 [5.6] years) were included in the analysis; 2050 of 2894 women (70.8%) received chemotherapy, and 2305 of 2880 women (80.0%) received endocrine therapy. After diagnosis, 1182 of 2625 patients (45.0%) at year 1 and 1553 of 2363 patients (65.7%) at year 2 reported consulting with a gynecologist in the previous year. At diagnosis, 1487 of 2744 patients (54.2%) reported contraceptive use, with most patients (921 of 1470 women [62.7%]) using hormonal methods. The use of contraception significantly decreased after diagnosis (911 of 2342 patients [38.9%] at year 1 and 808 of 1961 patients [41.2%] at year 2; P &lt; .001 for trend), when most patients (848 of 900 women [94.2%] at year 1 and 767 of 805 women [95.3%] at year 2) reported use of nonhormonal methods; these methods were primarily reversible mechanical approaches (copper intrauterine devices: 656 of 848 patients [77.4%] at year 1 and 577 of 767 patients [75.2%] at year 2; male condoms: 115 of 848 patients [13.6%] at year 1 and 110 of 767 patients [14.3%] at year 2). In the multivariable model, factors significantly associated with contraceptive use at year 1 included using contraception at diagnosis (adjusted odds ratio [aOR], 4.02; 95% CI, 3.15-5.14), being younger (aOR, 1.09; 95% CI, 1.07-1.13 per decreasing year), having better sexual function (aOR, 1.13; 95% CI, 1.07-1.19 per 10-point increment), having children (aOR, 4.21; 95% CI, 1.80-9.86), reporting the presence of leukorrhea (aOR, 1.32; 95% CI, 1.03-1.70), receiving tamoxifen treatment alone (aOR, 1.39; 95% CI, 1.01-1.92), and consulting with a gynecologist in the previous year (aOR, 1.29; 95% CI, 1.02-1.63). Similar factors were associated with contraceptive use at year 2, with the addition of partnered status (aOR, 1.61; 95% CI, 1.07-2.44).Conclusions and RelevanceFindings from this study support the importance of raising awareness and improving targeted contraceptive counseling for premenopausal women with early breast cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Contraceptive Use in Premenopausal Women With Early Breast Cancer

et al. 2022

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“…Endocrine therapy-related hot flashes predict the higher incidence of discontinuation with but with better prognosis [ 84 ]. The use of systemic hormone replacement therapy (HRT) to mitigate symptoms related with endocrine therapy is associated with an increased risk of recurrence in patients with estrogen receptor-positive BC [ 85 ].…”

Section: Side Effects Of Systemic Treatmentsmentioning

confidence: 99%

Long-Term Effects of Breast Cancer Therapy and Care: Calm after the Storm?

Tommasi

Balsano

Corianò

et al. 2022

JCM

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Breast cancer is still a lethal disease and the leading cause of death in women, undermining patients’ survival and quality of life. Modern techniques of surgery and radiotherapy allow for the obtaining of good results in terms of survival, however they cause long-term side effects that persist over time, such as lymphedema and neuropathy. Similarly, the advent of new therapies such as endocrine therapy revolutionized breast cancer outcomes, but side effects are still present even in years of follow-up after cure. Besides the side effects of medical and surgical therapy, breast cancer is a real disruption in patients’ lives considering quality of life-related aspects such as the distortion of body image, the psychological consequences of the diagnosis, and the impact on family dynamics. Therefore, the doctor-patient relationship is central to providing the best support both during treatment and afterwards. The aim of this review is to summarize the consequences of medical and surgical treatment on breast cancer patients and to emphasize the importance of early prevention of side effects to improve patients’ quality of life.

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“…In fact, they said, "Overall survival favored the ERT group." 81 In the most recently published review of this subject, Poggio et al 108 concluded that "use of HRTwas associated with a detrimental prognostic effect in breast cancer survivors." But their review offers no new information.…”

Section: What Are the Risks?mentioning

confidence: 99%

Hormone Replacement Therapy After Breast Cancer

Bluming¹

2022

Cancer J

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This article reviews the decades of evidence supporting the reproducible benefits of HRT for menopausal symptom control, improved cardiac health, prevention of hip fracture, reduction in the risk and pace of cognitive decline, and enhanced longevity. It quantifies the increased risk of thromboembolism associated with oral, though not transdermal, HRT. It evaluates the repeated claims that HRT is associated with an increased risk of breast cancer development, and, when administered to breast cancer survivors, an increased risk of breast cancer recurrence. Twenty-five studies of HRT after a breast cancer diagnosis, published between 1980 and 2013, are discussed, as are the 20 reviews of those studies published between 1994 and 2021. Only 1 of the 25 studies, the HABITS trial, demonstrated an increased risk of recurrence, which was limited to local or contralateral, and not distant, recurrence. None of the studies, including HABITS, reported increased breast cancer mortality associated with HRT. Even in the HABITS trial, the absolute increase in the number of women who had a recurrence (localized only) associated with HRT administration was 22. It is on the basis of these 22 patients that HRT, with its demonstrated benefits for so many aspects of women’s health, is being denied to millions of breast cancer survivors around the world.

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Safety of systemic hormone replacement therapy in breast cancer survivors: a systematic review and meta-analysis

Cited by 29 publications

References 18 publications

Contraceptive Use in Premenopausal Women With Early Breast Cancer

Contraceptive Use in Premenopausal Women With Early Breast Cancer

Long-Term Effects of Breast Cancer Therapy and Care: Calm after the Storm?

Hormone Replacement Therapy After Breast Cancer

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