Review Article

Hormone Replacement Therapy: An Increased Risk of Recurrence and Mortality for Breast Cancer Patients?

Molly Lupo, RN, MSN, ANP, NP-C, AOCNP® Joyce E. Dains, DrPH, JD, RN, FNP-BC, DPNAP, FAANP, and Lydia T. Madsen, PhD, RN, AOCNS®

MD Anderson Cancer Center, Houston, Texas

Authors' disclosures of potential conflicts of interest are found at the end of this article.

Molly Lupo, RN, MSN, ANP, NP-C, AOCNP®, 1220 Holcombe Boulevard ACB7, 2540, Unit 1374, Houston, TX 77030. E-mail: mrlupo@mdanderson.org


J Adv Pract Oncol 2015;6:322–330 | DOI: 10.6004/jadpro.2015.6.4.3 | © 2015 Harborside Press®


  

ABSTRACT

Historically, randomized controlled trials (RCTs) have shown an increased risk of recurrence and mortality among women who have used primarily oral HRT after breast cancer. However, many of these studies have had design flaws that may impact the findings. Numerous investigators have concluded that additional RCTs should be performed, but because of ethical issues and logistic challenges, large-scale RCTs are unlikely. Thus, the authors conducted an integrative review investigating recurrence and mortality data among breast cancer survivors who have used hormone replacement therapy (HRT). They recommend a stepwise algorithm for treating vaginal symptoms in breast cancer survivors: (1) start with nonhormonal treatments; (2) progress to a detailed discussion among patients and health-care professionals about the current known risks and benefits of vaginal estrogen; and (3) conclude with mutual decision-making between health-care providers and patients regarding the use of vaginal estrogen treatment.




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