Women Genetically Prone to Breast Cancer May Still Take HRT After Prophylactic Surgery
Women who carry the BRCA1 or BRCA2 genetic mutation, associated with higher risk of both breast and ovarian cancer, often opt for prophylactic surgery – mastectomy and/or salpingo-oophorectomy. Removing the ovaries has been shown to reduce cancer incidence in these women but brings on early menopause symptoms, and doctors often fear providing hormone replacement therapy because of the risks involved with excess estrogen. New study findings can ease those concerns, as researchers from the University of Pennsylvania have found that these women can safely take HRT after ovary removal.
Susan M. Domchek MD, an associate professor in the division of Hematology-Oncology and director of the Cancer Risk Evaluation Program, and colleagues followed 795 women with BRCA1 mutations and 504 women with BRCA2 mutations who had not enrolled in the PROSE (Prevention and Observation of Surgical Endpoints) consortium multicentre study. The women, all who had undergone prophylactic oophorectomy (removal of ovaries), were divided into groups of those who took HRT and those who did not.
Fourteen percent of the women who had undergone oophorectomy and took HRT developed breast cancer compared to 12 percent of the women who did not take HRT after surgery. The difference was not statistically significant, indicating that HRT did not greatly increase risk of the development of cancer.
“Women with BRCA1/2 mutations should have their ovaries removed following child-bearing because this is the single best intervention to improve survival,” said Dr. Domchek. “It is unfortunate to have women choose not to have this surgery because they are worried about menopausal symptoms and are told they can’t take HRT. Our data say that is not the case – these drugs do not increase their risk of breast cancer.”
“We know for sure that using HRT will mitigate menopausal symptoms, and we have pretty good evidence that it will help bone health,” she continues. “Women need to be aware that going into very early menopause does increase their risk of bone problems and cardiovascular problems. And even if they aren’t going to take HRT, they need to be very attentive to monitoring for those issues. But they also need to know that HRT is an option for them and to discuss it with their doctors and other caregivers.”
Dr. Domchek will present her team’s findings during the Cancer Prevention/Epidemiology Oral Abstract Session on Monday, June 6.
Reference: ASCO Abstract #1501: Is hormone replacement therapy (HRT) following risk-reducing salpingo-oophorectomy (RRSO) in BRCA1 (B1)- and BRCA2 (B2)-mutation carriers associated with an increased risk of breast cancer?