Biglia_subbed.qxp 22/4/09 09:27 Page 71
Hormone Replacement Therapy After Gynaecological Cancers
Vulvar Cancer the most frequently reported complaints, while osteoporosis and
Carcinoma of the vulva is an infrequent tumour, typical of advanced cardiovascular risk increase are long-term consequences.
age; its aetiology is not yet fully known. Normal and neoplastic vulva
tissue have oestrogen, progesterone and androgen receptors, but Recent data are encouraging in terms of the use of HRT in EC
epidemiological studies have not shown any association between the survivors, but as no randomised controlled studies are available,
patient’s reproductive history or taking oestrogen in menopause and decision-making should be shared with symptomatic patients after
in situ or invasive vulva carcinoma. In a case-control study, the RR of adequate discussion about the risks and benefits of therapy.
developing vulva carcinoma in women who had taken oestrogen was Furthermore, no evidence exists to show that HRT negatively
1.2 (95% CI 0.7–2.1) for in situ and 1.2 (95% CI 0.6–2.3) for invasive influences survival after treatment for ovarian cancer. Squamous cell
cancers; the data are not sufficient in terms of the effect of combining carcinoma and vulvar neoplasms do not appear to be influenced by
progesterone and oestrogens.
HRT use after cancer diagnosis, and the use of oestrogens for this
group of patients is generally allowed.
Similar results were reported in a recent Swedish study that
considered carcinoma of the vulva and vagina together, with an RR Fears and uncertainties persist for breast cancer survivors. Recent
of 1.2 for women on HRT (95% CI 0.7–1.8).
Therefore, it is data from an extended follow-up in the HABITS trial suggested that
hypothesised that there is no contraindication to the use of HRT in HRT induces and promotes breast cancer and may also stimulate the
women treated for vulvar neoplasms. growth of tumour microdeposits in breast cancer survivors. Moreover,
preliminary results from the LIBERATE study are not reassuring about
Conclusion the possibility of treating menopausal breast cancer patients with
Induced menopause after surgical or medical treatment for tibolone. Further studies are required in order to define the precise
gynaecological cancers deeply affects the quality of life of patients. indications for HRT; in the meantime, non-hormonal treatment is
Vasomotor symptoms, vaginal dryness and sexual dysfunctions are suggested to relieve oestrogen-deficiency-derived symptoms. ■
1. DiSaia PJ, Creasman WT, Adenocarcinoma of the uterus. estrogen plus progestin on gynecologic cancers and treatment, Eur J Surg Oncol, 1999;25:146–51.
In: DiSaia. PJ, Creasman WT (eds), Clinical gynecologic associated diagnostic procedures: the Women’s Health 29. Vassilopoulou-Sellin R, Asmar L, Hortobagyi GN, et al.,
oncology, 6th edn, Philadelphia: Mosby, 2002;137–71. Initiative randomized trial, JAMA, 2003;290:1739–48. Estrogen replacement therapy after localized breast
2. Grady D, Gebretsadik T, Ernster V, Petitti D, Hormone 15. Eeles RA, Tan S, Wiltshaw E, Fryatt I, et al., Hormone cancer. Clinical outcome of 319 women followed
replacement therapy and endometrial cancer risk: a replacement therapy and survival after surgery for ovarian prospectively, J Clin Oncol, 1999;17:1482–7.
metaanalysis, Obstet Gynecol, 1995;85:304–13. cancer, Br Med J, 1991;302:259–62. 30. Consensus Statement on Treatment of estrogen
3. Creasman WT, Henderson D, Hinshaw W, Clarke-Pearson 16. Ursic-Vrscaj M, Bebar S, Zakelj MP, Hormone replacement deficiency symptoms in women surviving breast cancer,
DL, Estrogen replacement therapy in the patient treated therapy after invasive ovarian serous cystadenocarcinoma J Clin Endocrinol Metab, 1998;83:1993–2000.
for endometrial cancer, Obstet Gynecol, 1986;67:326–30. treatment: the effect on survival, Menopause, 2001;8(1): 31. Vassilopoulou-Sellin R, Cohen DS, Hortobagyi GN, et al.,
4. Lee R, Burke T, Park R, Estrogen replacement therapy 70–75. Estrogen replacement therapy for menopausal women
following treatment for stage I endometrial carcinoma, 17. Guidozzi F, Daponte A, Estrogen replacement therapy for with a history of breast carcinoma, Cancer, 2002;95:
Gynecol Oncol, 1990;36:189–91. ovarian carcinoma survivors: a randomized controlled 1817–26.
5. Chapman J, DiSaia P, Osann K, et al., Estrogen trial, Cancer, 1999;86(6):1013–18. 32. Holmberg L, Anderson H, HABITS (hormonal replacement
replacement in surgical stages I and II endometrial cancer 18. Hopkins ML, Fung Kee Fun M, Lee T, Shorr R, Ovarian therapy after breast cancer – is it safe?), a randomised
survivors, Am J Obstet Gynecol, 1996;175:1195–1200. cancer patients and hormone replacement therapy: a comparison: trial stopped, Lancet, 2004;363:453–5.
6. Suriano KA, Mchale M, Mclaren CE, et al., Estrogen systematic review, Gyn Oncol, 2004;92:827–32. 33. Von Schoultz E, Rutqvist LE, on behalf of the Stockholm
replacement therapy in endometrial cancer patients: a 19. Mascarenahas C, Lambe M, Bellocco R, et al., Use of Breast Cancer Study Group: menopausal hormone
matched control study, Obstet Gynecol, 2001;97(4):555–60. hormone replacement therapy before and after ovarian replacement therapy afer breast cancer: the Stockholm
7. Barakat RR, Bundy BN, Spirtos NM, et al., A prospective cancer diagnosis and ovarian cancer survival, Int J Cancer, randomised trial, J Natl Cancer Inst, 2005;97:533–5.
randomized double-blind trial of estrogen replacement 2006;119:2907–15. 34. Holmberg L, Iversen OE, Magnus Rudenstam C, et al.,
therapy (ERT) vs placebo in women with stage I or II 20. Antoine C, Vandromme J, Fastrez M, et al., A survey Increased risk of recurrence after hormone replacement
endometrial cancer (EC): a Gynecologic Oncology Group among breast cancer survivors: treatment of the therapy in breast cancer survivors, J Natl Cancer Inst,
study, J Clin Oncol, 2006;24:587–92. climacteric after breast cancer, Climacteric, 2008;11(4): 2008;100:475–82.
8. Rossouw JE, Anderson GL, Prentice RL, et al., Risks and 322–8. 35. Dimitrakakis C, Keramopoulos D, Vourli G, et al., Clinical
benefits of estrogen plus progestin in healthy 21. North American Menopause Society, Treatment of effects of tibolone in postmenopausal women after 5
postmenopausal women: Principal results from the menopause-associated vasomotor symptoms: position years of tamoxifen therapy for breast cancer, Climacteric,
Women’s Health Initiative randomised controlled trial, statement of the North American Menopause Society, 2005;8:342–51.
JAMA, 2002;288:321–33. Menopause, 2004;11:11–13. 36. Kroiss R, Fentiman IS, Helmond FA, et al., The effect of
9. Ayhan A, Taskiran C, Simsek S, Sever A, Does immediate 22. Dew J, Eden J, Beller E, et al., A cohort study of hormone tibolone in postmenopausal women receiving tamoxifen
hormone replacement therapy affect the oncologic replacement therapy given to women previously treated after surgery for breast cancer: a randomised, double-
outcome in endometrial cancer survivors?, Int J Gynecol for breast cancer, Climateric, 1998;1(2):137–42. blind, placebo-controlled trial, Br J Obstet Gynaecol,
Cancer, 2006;16:805–8. 23. DiSaia PJ, Grosen EA, Kurosaki T, et al., Hormone 2005;112:228–33.
10. McDonnell BA, Twiggs LB, Hormone Replacement Therapy replacement therapy in breast cancer survivors: a cohort 37. Biglia N, Mariani L, Marenco D, et al., Hormonal
in endometrial cancer survivors: new perspectives after study, Am J Obstet Gynecol, 1996;174:1494–8. replacement therapy after gynaecological cancer, Gynakol
the heart and estrogen progestin replacement study and 24. Eden JA, Bush T, Nand S, A case-control study of Geburt Rundsch, 2006;46:191–96.
the women’s health initiative, J Low Genit Tract Dis, 2006; combined continous estrogen-progestin replacement 38. Ploch E, Hormonal replacement therapy in patients after
10(2):92–101. therapy among women with a personal history of breast cervical cancer treatment, Gynecol Oncol, 1997;26(2):
11. Genazzani AR, Gaducci A, Ganbacciani M, Hormone cancer, Menopause North Am Menopause Soc, 1995;2:67–72. 169–77.
replacement therapy and cancer. International 25. Marsden J, Baum M, Withehead MI, et al., A randomised 39. Lacey JV, Brinton LA, Barnes WA, et al., Use of hormone
Menopause Society Expert Workshop, Gynecol Endocrinol, trial of HRT in women with a history of breast cancer: a replacement therapy and adenocarcinomas and
2001;15(6):453–65. feasibility study, Acta Obstet Gynecol Scand, 1997;76 squamous cell carcinomas of the uterine cervix, Gynecol
12. Coughlin SS, Giustozzi A, Smith SJ, Lee NC, A metaanalysis (Suppl. 167):22, abstract. Oncol, 2000;77:149–54.
of estrogen replacement therapy and risk of epibreak 26. Powles TJ, Hickish T, Casey S, Hormone replacement after 40. Sherman KJ, Daling JR, McKnight B, Chu J, Hormonal
thelial ovarian cancer, J Clin Epidemiol, 2000;53(4):367–75. breast cancer, Lancet, 1993;342:60–61. factors in vulvar cancer. A case-control study, J Reprod Med,
13. Garg PP, Kerlikowscke K, Subac L, Grady D, Hormone 27. Stoll BA, Hormone replacement therapy in women treated 1994;39:857–61.
replacement therapy and the risk of epithelial ovarian for breast cancer, Eur J Clin Oncol, 1989;25:1909–13. 41. Persson I, Weiderpass E, Bergkvist L, et al., Risks of breast
carcinoma: a meta-analysis, Obst Gynecol, 1998;92:472–9. 28. Ursic-Vrscaj M, Bebar S, A case-control study of hormone and endometrial cancer after estrogen and progestin
14. Anderson GL, Judd HL, Kaunitz AM, et al., Effects of replacement therapy after primary surgical breast cancer replacement, Cancer Causes Control, 1999;10:253–60.
EUROPEAN OBSTETRICS & GYNAECOLOGY 71
| Page 2
| Page 3
| Page 4
| Page 5
| Page 6
| Page 7
| Page 8
| Page 9
| Page 10
| Page 11
| Page 12
| Page 13
| Page 14
| Page 15
| Page 16
| Page 17
| Page 18
| Page 19
| Page 20
| Page 21
| Page 22
| Page 23
| Page 24
| Page 25
| Page 26
| Page 27
| Page 28
| Page 29
| Page 30
| Page 31
| Page 32
| Page 33
| Page 34
| Page 35
| Page 36
| Page 37
| Page 38
| Page 39
| Page 40
| Page 41
| Page 42
| Page 43
| Page 44
| Page 45
| Page 46
| Page 47
| Page 48
| Page 49
| Page 50
| Page 51
| Page 52
| Page 53
| Page 54
| Page 55
| Page 56
| Page 57
| Page 58
| Page 59
| Page 60
| Page 61
| Page 62
| Page 63
| Page 64
| Page 65
| Page 66
| Page 67
| Page 68
| Page 69
| Page 70
| Page 71
| Page 72
| Page 73
| Page 74
| Page 75
| Page 76
| Page 77
| Page 78
| Page 79
| Page 80
| Page 81
| Page 82
| Page 83
| Page 84