Hormone replacement therapy in women treated for gynaecological malignancy

Can we prescribe hormone replacement therapy (HRT) safely for women, with p ostmenopausal complaints who were treated for a gynaecological malignancy? Only three retrospective studies have investigated this issue in endometria l cancer patients. No recurrences or deaths occurred in these treated group s. However, the physician introduced bias through the selection of favourab le groups. At present, combined estrogen and progestogen therapy is probabl y not contra-indicated in endometrial cancer stage I and probably also not in stage II, although so far there is only circumstantial evidence. Squamou s cell cancers of the cervix, vulva, and vagina are unlikely to be influenc ed by HRT. In the only study available of women with ovarian cancer, less t han or equal to 50 years, estrogen replacement therapy did not have a negat ive influence on (disease-free) survival. According to the data currently a vailable, no evidence exists that HRT adversely influences survival and ove rall survival after treatment for ovarian cancer. In general, adenocarcinom as of the cervix and leiomyosarcomas of the uterus may be managed such as t he adenocarcinomas of the uterus. During the last 25 years, HRT has been sh own to substantially reduce the risk of cardiovascular diseases, osteoporot ic fractures and colon carcinoma. On the other hand there is a significant increase of the risk in breast cancer with prolonged use of > 5 years. Re-e valuation of the current view that HRT should no be given to women treated for a gynaecological malignancy is strongly warranted after evaluating the advantages and the disadvantages of HRT use in each individual patient. Lon g-term HRT in women treated for a gynaecological cancer must be based on th e medical history of the individual patient (and her family). (C) 1998 Else vier Science Ireland Ltd. All rights reserved.