Hormone replacement therapy and breast cancer

The use of hormone replacement therapy by postmenopausal women with a histo ry of breast cancer is a subject of considerable controversy. There are no scientific studies that have appropriately examined the:issue, and current practice is often based on inferences from indirect evidence, anecdotal exp erience, and personal bias. Our understanding of the effects of exogenous, as well as endogenous, hormones on normal and neoplastic breast tissue prov ides some insights but is not an appropriate basis for clinical practice. T he effects of exogenous hormone replacement on the overall health of postme nopausal women, including psychosocial issues, cardiovascular risks, and th e morbidity of osteoporosis, must be understood before patients can be coun seled appropriately. Treatment of patients must be individualized The rapid ly expanding area of nonhormonal therapies for the treatment of postmenopau sal health risks and the treatment of symptomatic complaints in postmenopau sal women has already led to a reevaluation of the use of exogenous hormone s among all women. A prospective randomized trial that examines the effects of hormone replacement on women with a history of breast cancer is current ly underway and will provide valuable data to address these issues. The aim of this review is to outline the scientific basis for the association betw een estrogen and breast cancer and to provide a framework in which individu alized recommendations concerning the use of hormone replacement therapy ca n be made for patients with breast cancer.