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Dr. Pritchard is Head of Clinical Trials and Epidemiology, Toronto Sunnybrook Regional Cancer Centre, and Professor in the Department of Medicine, University of Toronto, Toronto, Ont.; Ms. Khan is Research Assistant, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont.; Dr. Levine is Professor in the Departments of Medicine and Clinical Epidemiology and Biostatistics and is the Buffet Taylor Chair in Breast Cancer Research, McMaster University, Hamilton, Ont.Members (and nominating organizations) of the Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer Chair: Dr. Mark Levine (Cancer Care Ontario), Hamilton Regional Cancer Centre and McMaster University, Hamilton, Ont. Members: Dr. Penny Barnes, Queen Elizabeth II Health Sciences Centre, Halifax, NS; Dr. David M. Bowman (Manitoba Cancer Treatment and Research Foundation), Manitoba Cancer Treatment and Research Foundation, Winnipeg, Man.; Dr. Judy Caines (Federal/Provincial/Territorial Advisory Committee on Health Services), Nova Scotia Cancer Centre, Halifax, NS; Dr. Jacques Cantin (Royal College of Physicians and Surgeons of Canada), Centre hospitalier de l'Université de Montréal, Montreal, Que.; Dr. Beverley Carter, Hamilton Health Sciences, Henderson General Hospital, Hamilton, Ont.; Ms. Chris Emery (Canadian Nurses Association), BC Cancer Agency, Delta, BC; Dr. Eva Grunfeld (College of Family Physicians of Canada), Ottawa Regional Cancer Centre, Ottawa, Ont.; Dr. Maria R. Hugi (Canadian Breast Cancer Network), Providence Health Care, Vancouver, BC; Dr. Alan W. Lees (Alberta Cancer Board), Cross Cancer Institute, Edmonton, Alta.; Ms. Sabina Mallard (Canadian Breast Cancer Network), consumer representative, Stratford, PEI; Dr. Mohamed Mohamed (Saskatchewan Cancer Foundation), Saskatoon Cancer Centre, Saskatoon, Sask.; Dr. Ivo A. Olivotto (BC Cancer Agency), Vancouver Island Cancer Centre and University of British Columbia, Victoria, BC; Dr. Leonard Reyno (Cancer Care Nova Scotia), Nova Scotia Cancer Centre, Halifax, NS; Dr. Carol Sawka (Cancer Care Ontario), Toronto Sunnybrook Regional Cancer Centre, Toronto, Ont.; Dr. Hugh Scarth (Atlantic Health Sciences Corporation), Saint John Regional Hospital, Saint John, NB; Ms. Jennifer Van Koeveringe (Health Canada), Cancer Division, Centre for Chronic Disease Prevention and Control, Health Canada, Ottawa, Ont.; and Dr. Timothy Whelan (Cancer Care Ontario), Hamilton Regional Cancer Centre and McMaster University, Hamilton, Ont.
Correspondence to: Dr. Mark Levine, Rm. 9-90 Wing, Henderson Hospital, 711 Concession St., Hamilton ON L8V 1C3
Objective: To provide information and recommendations to women with a previous diagnosis of breast cancer and their physicians regarding hormone replacement therapy (HRT).
Outcomes: Control of menopausal symptoms, quality of life, prevention of osteoporosis, prevention of cardiovascular disease, risk of recurrence of breast cancer, risk of death from breast cancer.
Evidence: Systematic review of English-language literature published from January 1990 to July 2001 retrieved from MEDLINE and CANCERLIT.
Recommendations: · Routine use of HRT (either estrogen alone or estrogen plus progesterone) is not recommended for women who have had breast cancer. Randomized controlled trials are required to guide recommendations for this group of women. Women who have had breast cancer are at risk of recurrence and contralateral breast cancer. The potential effect of HRT on these outcomes in women with breast cancer has not been determined in methodologically sound studies. However, in animal and in vitro studies, the development and growth of breast cancer is known to be estrogen dependent. Given the demonstrated increased risk of breast cancer associated with HRT in women without a diagnosis of breast cancer, it is possible that the risk of recurrence and contralateral breast cancer associated with HRT in women with breast cancer could be of a similar magnitude. · Postmenopausal women with a previous diagnosis of breast cancer who request HRT should be encouraged to consider alternatives to HRT. If menopausal symptoms are particularly troublesome and do not respond to alternative approaches, a well-informed woman may choose to use HRT to control these symptoms after discussing the risks with her physician. In these circumstances, both the dose and the duration of treatment should be minimized.
Validation: Internal validation within the Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer; no external validation.
Sponsor: The steering committee was convened by Health Canada.
Completion date: October 2001.
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  J. W. Goodwin, S. J. Green, C. M. Moinpour, J. D. Bearden III, J. K. Giguere, C. S. Jiang, S. M. Lippman, S. Martino, and K. S. Albain Phase III Randomized Placebo-Controlled Trial of Two Doses of Megestrol Acetate as Treatment for Menopausal Symptoms in Women With Breast Cancer: Southwest Oncology Group Study 9626 J. Clin. Oncol., April 1, 2008; 26(10): 1650 - 1656. [Abstract] [Full Text] [PDF]
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 M. Trinkaus, S. Chin, W. Wolfman, C. Simmons, and M. Clemons Should Urogenital Atrophy in Breast Cancer Survivors Be Treated with Topical Estrogens? Oncologist, March 1, 2008; 13(3): 222 - 231. [Abstract] [Full Text] [PDF]
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