BMJ  2003;326:1398 (21 June), doi:10.1136/bmj.326.7403.1398

Letter

Making decisions about hormone replacement therapy

Preparations containing oestrogen should not be given during treatment for breast cancer

EDITOR—We read with interest the clinical review by Rymer et al on making decisions about hormone replacement.¹ The article provides a useful and informed guide to the indications for hormone replacement and a helpful analysis of the risks and benefits.

We take issue, however, on one important point. As a surgical oncology team specialising in the treatment of breast cancer we believe that it is important to point out that the therapeutic value of gonadotrophin releasing hormone analogues in the treatment of breast cancer is based on their suppression of ovarian function and the consequent reduction in the concentrations of circulating oestrogen in premenopausal women whose tumours are oestrogen receptor positive.^{2 3} In these women preparations containing oestrogen should not be used since their use will compromise the value and efficacy of treatment for breast cancer.

The use of hormone replacement in women who have been treated at some time in the past for breast cancer may well be safe, but it should not be used concurrently with treatments aimed at ovarian suppression.

christopherhinton{at}tiscali.co.uk

Princess Royal Hospital NHS Trust, Telford, Shropshire TF1 6TF

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Competing interests: None declared.

References

1. Rymer J, Wilson R, Ballard K. Making decisions about hormone replacement therapy. BMJ 2003;326: 322-6. (8 February.)[Free Full Text]
2. Taylor CW, Green S, Dalton WS, Martino S, Rector D, Ingle JN, et al. Multicenter randomised clinical trial of goserelin versus surgical ovariectomy in pre-menopausal patients with receptor positive metastatic breast cancer: an intergroup study. J Clin Oncol 1998;16: 994-9.[Abstract]
3. Boccardo F, Rubagotti A, Perrotta A, Amoroso D, Balestrero M, De Matteis A, et al. Ovarian ablation versus goserelin with or without tamoxifen in pre-menopausal patients with advanced breast cancer: results of a multicentric Italian study. Ann Oncol 1994;5: 337-42.[Abstract/Free Full Text]

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