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Breast Cancer Risk with Menopausal Hormone Use

Breast Cancer Risk with Menopausal Hormone Use. Jackie Bouillon Advisor: Dr. Robert Hadley Spring 2007. The HRT Controversy. HRT was standard of therapy for menopausal symptoms for years In early 2000’s positive view of HRT was changed with the results of WHI and HERS studies

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Breast Cancer Risk with Menopausal Hormone Use

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  1. Breast Cancer Risk with Menopausal Hormone Use Jackie Bouillon Advisor: Dr. Robert Hadley Spring 2007

  2. The HRT Controversy • HRT was standard of therapy for menopausal symptoms for years • In early 2000’s positive view of HRT was changed with the results of WHI and HERS studies • Showed association between HRT and increased risk for breast cancer, heart attack, stroke

  3. Factors leading to worse prognosis Adiposity Smaller body size and HRT use Long term unopposed estrogen use (>15 yrs) Combined estrogen-progesterone regimens Positive hormone tumor status (ER+/PR+) Higher tumor grade Factors that do not lead to worse prognosis HRT use if overweight (no additional increased risk) Short-term unopposed estrogen use (<15 yrs) Negative hormone receptor tumor status (ER+/PR- or ER-/PR-) Summary of HRT and Factors Associated with Breast Cancer

  4. HRT After Breast Cancer • What about HRT for women with a history of breast cancer? • Very controversial issue • Typically HRT is avoided by women with prior breast cancer diagnosis for fear of recurrence • Most observational studies suggest that HRT does NOT increase breast cancer recurrence and mortality in women with a prior diagnosis

  5. HRT After Breast Cancer • First 2 randomized controlled trials were stopped prematurely after showing an increase in recurrence with HRT use • HABITS Trial: rate of recurrence significantly higher with HRT use • Stockholm Trial: no associated increase in recurrence with HRT use

  6. HABITS Trial Participants had higher grade lymph node involvement Majority of women used combined HRT; small percentage used unopposed estrogen Stockholm Trial Participants had lower grade lymph node involvement Majority of women used unopposed estrogen or combined in which progesterone was taken for short intervals Why the Disparity in the Results?

  7. Conclusions • More clinical trials needed before can make conclusions about HRT after breast cancer • Providers need to be aware of the factors associated with increased breast cancer risk • Providers need to work with each patient individually to assess her need for HRT and risk factors to determine if HRT is appropriate

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