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Exogenous reproductive hormone use in breast cancer survivors and previvors

Nature Reviews Clinical Oncology volume 15, pages 249–261 (2018)Cite this article

Subjects

Key Points

  • Oral hormonal contraception might slightly increase the risk of breast cancer, and its use is contraindicated in breast cancer survivors, but hormonal intrauterine devices might be safe for patients receiving tamoxifen; nonhormonal contraceptives are also available

  • Women treated with long-term hormone-replacement therapy (HRT) with conjugated oestrogen and progestin have an increased risk of breast cancer, but those receiving unopposed oestrogens do not

  • Short-term HRT before 50 years of age seems to be safe for women carrying mutations in BRCA1 and/or BRCA2 who have undergone prophylactic oophorectomy procedures

  • The safety of local HRT, which is typically used to relieve sexual dysfunction, remains to be determined, particularly among patients with hormone-receptor-positive tumours receiving endocrine therapy

  • Effective alternatives to HRT are available for the treatment of menopausal symptoms associated with endocrine therapy

  • Safe and effective options can be offered to patients with breast cancer who require hormonal manipulation in order to proceed with fertility preservation techniques

Abstract

Considerable controversy exists regarding the safety of elective exogenous hormonal exposure among breast cancer survivors and women at high risk of developing the disease (referred to herein as 'previvors'). We performed a qualitative analysis focused on four areas of potential exogenous exposure to hormones among previvors and survivors: hormonal contraception; systemic hormone-replacement therapy (HRT); localized HRT; and hormonal manipulation for fertility preservation or enhancement. Herein, we discuss the available data and present clinical recommendations regarding the safety of hormonal exposure for both previvors and survivors. We found these data to be hampered by small cohort sizes, heterogeneous patient populations, and limited study designs, highlighting a great need to conduct further research with the aim of enabling better-informed patient management.

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Figure 1: Interplay between oestrogens and oestrogen deprivation.

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Acknowledgements

The authors thank K.T. Bifolck (Dana–Farber Cancer Insititute, Boston, Massachusetts, USA), for her help with language editing and manuscript formatting.

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Authors and Affiliations

  1. Department of Medical Oncology, Dana–Farber Cancer Institute, 450 Brookline Avenue, Boston, 02215, Massachusetts, USA

    Ines Vaz-Luis & Ann H. Partridge

  2. INSERM UMR981 Department of Medical Oncology, Institut Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif, 94800, France

    Ines Vaz-Luis

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  1. Ines Vaz-Luis
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Vaz-Luis, I., Partridge, A. Exogenous reproductive hormone use in breast cancer survivors and previvors. Nat Rev Clin Oncol 15, 249–261 (2018). https://doi.org/10.1038/nrclinonc.2017.207

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