Hormone replacement therapy after treatment of breast cancer: Effects on postmenopausal symptoms, bone mineral density and recurrence rates

Purpose: Breast cancer (BC) is the most frequent female carcinoma and the m ajor cause of death in women aged 35-50 years. The total number of patients surviving BC and especially the morbidity rate of patients below the age o f 55 years has increased significantly in the last several years. As a cons equence, the number of BC patients suffering from the long-term effects of estrogen deficiency due to adjuvant treatment is increasing. At present, ho rmone replacement therapy (HRT) following BC treatment is applied individua lly and mainly depends on the severity of postmenopausal symptoms (PMS) exp erienced by these patients. Patients and Methods: In a retrospective study (total n = 185 BC patients, 64 with and 121 without HRT), the effect of HRT during or after adjuvant therapy [chemotherapy and/ or (anti-) hormonother apy] has been investigated. The surveillance period was up to 60 months. Ev aluated were HRT effects on (1) PMS measured by a comprehensive life qualit y questionnaire, (2) bone mineral density (BMD) measured by osteodensitomet ry and (3) morbidity as well as mortality rates. Results: Both groups did n ot differ with regard to tumor stage, lymph node involvement, metastasis, g rading, and steroid hormone receptor status. A reduction in PMS was signifi cant in women taking HRT (p < 0.001), especially in the subgroup of women l ess than or equal to 50 years (p < 0.0001). For both age groups, the median reduction in BMD (z-score) was less in women receiving HRT ( less than or equal to 50 years: without HRT -1.99 vs. with HRT -0.95, p <0.05; > 50 year s: without HRT -2.29 vs. with HRT -1.19, p < 0.01). There were no statistic ally significant differences regarding morbidity and mortality (p = 0.29). Conclusion: In this study of BC patients, the use of HRT shows positive eff ects on PMS and BMD. There was no significant influence on morbidity or mor tality. However, a reevaluation of HRT in the routine management of BC pati ents should await the results of prospective randomized trials. Copyright ( C) 2001 S. Karger AG, Basel.