Hormone replacement therapy following breast cancer

Breast cancer is a common disease with a rising incidence, preferably in peri-and postmenopausal women. Because of improvements in early diagnosis and screening and because of more effective therapy, an increasing number of premenopausal patients with a history of breast cancer will come into the age of menopause, and like all other women they are confronted with its problems and symptoms. Recent reports, indicating an elevated risk of breast cancer by hormone replacement therapy, have stimulated the discussion about its safety and use in breast cancer survivors. Until today no randomized studies have been reported. Available though only preliminary data do not show an adverse effect of hormone replacement therapy (estrogens and gestagens) in breast cancer survivors. These data, however, are weakened by the low number of cases and a short observation time, Due to the fact that these data are not confident enough, an individual strategy is necessary in counselling patients with breast cancer history, The risk of menopausal diseases and/or symptoms have to be balanced against the risk of inducing breast cancer or its recurrence. Therefore, a general medical advice cannot be given at present. Great hope is implemented by the development of new antiestrogen compounds which will protect breast tissue in a selective way, whereas they will exert the beneficial estrogen effects in other organ systems.