HORMONE REPLACEMENT THERAPY AND GYNECOLOGIC CANCER

In view of the growing number of postmenopausal women using estrogen r eplacement therapy for the prevention of acute and chronic consequence s of hypoestrogenism, any possible associations between hormone therap y and manifestations of gynecologic cancer are an issue of increasing importance, We reviewed the published literature to evaluate the impac t of estrogen replacement therapy on the occurrence of gynecologic mal ignancies including breast cancer, The tumor growth of ovarian, cervic al, vaginal, and vulvar neoplasias is not fundamentally influenced by hormone therapy. However, long-term replacement therapy may be associa ted with an increased incidence of endometrial hyperplasia and even of neoplasia. This increased risk is related to the duration and cumulat ive dose of estrogen therapy. Addition of progestin probably reduces t he risk of endometrial cancer to that observed in the general populati on. With regard to the relationship between hormone replacement therap y and the incidence of breast cancer, available epidemiologic data are contradictory, While therapy of less than 5 years appears not to be a ssociated with an increased risk? long-term use may be related to a sm all but significant increase in the risk of developing breast cancer. II is important to note that the cyclic addition of a progestin to est rogen replacement does not affect this risk, After discontinuation of hormone replacement the increased relative risk returns to that of non -users. In conclusion, when considering estrogen replacement therapy f or a postmenopausal woman, a slightly increased risk of developing bre ast cancer and the need to add progestin for protection of the endomet rium need to be mentioned, Bearing this in mind, the benefits of estro gen therapy in terms of a better quality of life and perhaps of a dise ase-free prolongation of life justify a wide use of hormonal preparati ons.