Are older breast carcinoma survivors willing to take hormone replacement therapy?

BACKGROUND. Breast carcinoma survivors are the largest segment of the expan ding cancer survivor community. As a result, there has been increasing disc ussion of the safety and efficacy of hormone replacement therapy for women with a past history of breast carcinoma. Little is known about the willingn ess of older breast carcinoma survivors to accept hormone replacement thera py for the alleviation of menopausal symptoms (such as hot flashes, vaginal dryness, and urinary incontinence) or for reduction in the risk of serious heart disease or osteoporotic hip fracture. METHODS. A structured decision analysis interview was conducted, in which v isual aids were used to describe therapy and hypothetical risks of breast c arcinoma recurrence. Subjects were presented with a series of scenarios in which a hypothetical woman might be experiencing one of several menopausal symptoms or might have a reduction in the risk of serious heart disease or osteoporotic hip fracture. RESULTS. Thirty-nine disease free breast carcinoma survivors who were age 6 0 years or older were recruited to participate in a study that included int erview and physical examination. Subjects were age 68.3 years on average an d had been diagnosed with breast carcinoma an average of 3.1 years previous ly. The majority had received hormone replacement therapy at some point in the past. They showed high levels of functioning as measured by the RAND Sh ort Form Health Survey. Willingness to take estrogen was evident only when the increase in the risk of breast carcinoma recurrence was small and when severe symptoms of menopause were present. Under the hypothetical condition s of this interview, 56.4% of these 39 breast carcinoma survivors would he willing to take estrogen if they had all 3 menopausal symptoms and their ri sk of breast carcinoma recurrence increased from 25% to 32%. In contrast, f or the osteoporosis and heart disease scenarios (in which women were as yet asymptomatic), only 17.9% were willing tc, take estrogen to reduce the ris k of hip fracture by 50% and only 28.2% were willing to take estrogen to re duce the risk of heart attack by 50% under the same assumption of a 7% diff erence in the risk of recurrence (from 25% to 32%). CONCLUSIONS. Overall, the study findings demonstrate the reluctance of thes e older breast carcinoma survivors to lake estrogen after a breast carcinom a diagnosis. There was an increased willingness to consider therapy if mult iple symptoms coexisted and the possible risk of recurrence was small (13% compared with 10%). There was also no significant correlation between curre nt menopausal symptoms and the willingness to take estrogen in the hypothet ical situations posed in the interview. These findings suggest an important feasibility problem that must be addressed before hormone replacement clin ical trials involving breast: carcinoma survivors are launched. (C) 1999 Am erican Cancer Society.