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Hormonal Replacement Therapy in Cancer Survivors: Safety, Benefits, and Clinical Guidelines

The primary oncologic concern surrounding Hormonal Replacement Therapy (HRT) in cancer survivors is its potential to stimulate tumor growth or recurrence through hormone receptor–mediated mechanisms. In breast, endometrial, and prostate cancers—where tumor biology is often driven by estrogen or androgen signaling—exogenous hormone exposure may reactivate dormant cancer cells or accelerate proliferation of residual disease. In estrogen receptor–positive (ER+) and/or progesterone receptor–positive (PR+) breast cancer, HRT raises particular concern due to the potential for estrogen to directly stimulate malignant cell growth. Several landmark studies have investigated this risk. The HABITS trial…

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 Misconceptions Keep Some Cancer Patient Populations From Benefitting From Hormone Therapy

Despite evidence suggesting the safety of hormone therapy for patients with a history of low-grade endometrial or epithelial ovarian cancer, a new survey shows that many gynecologists and some gynecologic oncologists are still uncomfortable prescribing the therapy for this patient population. This indicates a need for more clinician education to help overcome lingering misconceptions. Results of the survey are published online today in Menopause, the journal of The Menopause Society.

Articles of Interest

Hormone replacement in survivors of childhood cancer and brain tumors: safety and controversies

To the best of our knowledge, despite the proliferative potential of thyroid hormones and sex steroids, there is currently no evidence supporting worse cancer or tumor outcomes when CCS with established deficiencies in these hormones are treated at substitutive doses.

Hormone Replacement Therapy in Cancer Survivors – Review of the Literature

Hormone replacement therapy (HRT; also known as menopausal hormone therapy, MHT) means substituting estrogen (or compounds exerting estrogenic effects) and progesterone (or compounds exerting progestagenic effects) after the cessation of cyclic ovarian hormone production. In the context of young oncologic patients with premature ovarian insufficiency (POI) the term HRT seems to be more appropriate then MHT. Oncologic risk of MHT requires consideration from two aspects: the potential of MHT to induce tumours in patients who have no oncologic history; and the potential to cause cancer recurrence and progression in cancer survivors. The former question is frequently asked by patients and needs to be explained to those who receive MHT.

Hormone replacement therapy in female-specific cancer survivors: considerations beyond cancer cure

This review provides an updated overview of HRT in women with a history of cervical, endometrial, ovarian, and breast cancers. For cervical cancer, HRT is not contraindicated in either squamous cell carcinoma or adenocarcinoma, regardless of stage. For endometrial cancer, HRT is not contraindicated in early-stage disease with no residual tumor, although it should be avoided in low-grade endometrial stromal sarcoma. HRT is not contraindicated in epithelial ovarian cancer regardless of stage, except in low-grade serous carcinoma. Currently, HRT is contraindicated for breast cancer.

Hormone replacement therapy in women with cancer and risk of cancer-specific mortality and cardiovascular disease: a protocol for a cohort study from Scotland and Wales

An increasing number of women with cancer experience menopausal symptoms. HRT is contraindicated in patients with breast cancer and oestrogen-dependent cancers but not in patients with other cancers and authors have argued against the denial of HRT in these patients except when based upon evidence, given the benefits of HRT. Numerous researchers have made recommendations, based upon limited evidence, for and against the use of HRT in patients with cancer depending upon the site of their cancer