Breast cancer, treatment estrogen replacement therapy

One also finds a critical view expressed in the USA, where a survey of the literature up to the end of 1999 concluded that while raloxifene might carry a lesser risk of breast cancer than estrogen replacement therapy, it was also less effective in maintaining bone density, and that as regards cardiovascular risk the estrogenic treatment produced a more favorable outcome (7). 

Estrogen replacement therapy (ERT) demonstrated effectiveness in reducing the frequency and severity of some menopause-related conditions and, therefore, became the treatment of choice for women with such symptoms. Unfortunately, patient compliance was compromised by the undesirable side effects associated with ERT, and its utility and widespread use were significantly limited after the publication of wide-scale studies showing that ERT increases the risk of breast cancer, endometrial cancer, and thrombosis.9... 

In a reanalysis of 51 studies, less than 5 years of therapy with combined estrogen and progestogen was associated with a 15% increase in risk for breast cancer, and the risk increased with greater duration of treatment. Five years after discontinuation of hormone replacement therapy, the risk of breast cancer was no longer increased. 

Besides contraception, the uses of estrogens can largely be put into three main groups the management of the menopausal and postmenopausal syndrome (its widest use) physiological replacement therapy in deficiency states and the treatment of prostatic cancer and of breast cancer in postmenopausal women. 

The chief therapeutic uses of estrogens and progestins are as oral contraceptives and hormone replacement therapy. Progestins and SERMs are also important agents in the treatment of osteoporosis, breast cancer, endometrial cancer, and infertility. 

However, estrogen has been demonstrated to be associated with the increased incidence of breast and endometrial cancer after prolonged treatment. In addition, during HRT, venous thrombo-embolic complications are encountered more frequently than in women not undergoing HRT [71]. Therefore, there is a growing interest in using isoflavones as a potential alternative to the estrogens in hormone replacement therapy. 

Doctors advise many menopausal patients to counter their symptoms with hormone replacement therapy, but this approach isn t appropriate for all women. A family history of breast or uterine cancer precludes estrogen treatment, as does a history of chronic liver disease. 

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