POSTMENOPAUSAL HORMONE REPLACEMENT THERAPY AND CANCER OF THE FEMALE GENITAL-TRACT AND BREAST

Taking into account data from recent case-control and cohort studies, this review addresses anew the controversial issue of a possible relat ionship between hormone replacement therapy and an increased risk of f emale cancer. The adequate addition of a progestogen reduces considera bly the significantly increased risk of endometrial cancer seen in cur rent and in past long-term estrogen replacement therapy (ERT) users. H owever, a small risk increase might still be present with combined est rogen-progestogen replacement therapy (EPRT), and with low-dose contin uous combined treatment. Whether long-term hormone replacement therapy increases the risk of breast cancer remains controversial. All four r ecent case-control studies report a small, marginally significant risk increase of about 20-30%, while two recent cohort studies are very re assuring. Sequential addition of a progestogen does not seem to influe nce breast cancer risk. Unfortunately, no data are available on the bo th practically and theoretically interesting option of continuous comb ined hormone replacement therapy. It can be concluded from the present data that hormone replacement therapy can be safely prescribed for pe riods of less than five years to women with climacteric symptoms. Shor t-term hormone replacement therapy for climacteric complaints in women who have been treated for the above-mentioned cancers should not be c onsidered to be absolutely contraindicated as the available but scanty new data do not indicate any detrimental effect in such women. 1040-8 72X (C) 1998 Rapid Science Publishers.