Why Some Doctors May Consider HRT for Breast Cancer Survivors
But some doctors believe that systemic HRT should remain open for discussion after breast cancer treatment, especially when menopause symptoms severely affect a woman’s quality of life. That does not mean they consider it risk-free.
Instead of viewing HRT as off-limits for every survivor, Dr. Bluming believes that women and their doctors should discuss it, taking into account recurrence risk and the impact of menopause symptoms on quality of life. He also notes that current research can’t tell an individual woman how taking HRT would affect her risk of cancer returning, saying “we don’t know enough.”
Other doctors are open to HRT after other options have failed. Dr. Nachtigall may prescribe it for breast cancer survivors with significant symptoms that have not improved with nonhormonal treatments. “You’d rather not use estrogen if you can help it,” she says, but she believes that persistent, severe symptoms deserve an evaluation.
Kling reaffirms that systemic HRT is generally discouraged after HR+ breast cancer. But she supports a conversation among the patient, a menopause specialist, and their oncologist about symptoms, nonhormonal options, and cancer-related risks. For some carefully selected patients, that conversation may include systemic HRT, she says.
Dr. Wu’s view is similar. She recommends trying nonhormonal medications first, and she supports vaginal estrogen for genitourinary symptoms for patients with HR+ breast cancer. In select cases, she has supported HRT. One example is a patient who was 20 years past her HR+ breast cancer diagnosis who had tried nonhormonal options, understood that HRT could increase her risk of breast cancer recurrence, and still wanted to try HRT to improve her quality of life. Wu is clear that this individual decision doesn’t mean HRT is appropriate for every HR+ breast cancer survivor.
Dr. Larkin emphasizes that systemic HRT drug labels still list breast cancer or a history of breast cancer as a contraindication, meaning a reason not to use the medication. She recommends nonhormonal treatments first, though she believes that refusing to consider HRT can overlook important differences between women.
“My oncologist did concede that my risk of local and distant recurrence [cancer returning near its original site or elsewhere in the body] was small if I did not take an estrogen blocker and that I did not have to,” DeVita says.
She also wanted a conversation that looked at the whole picture: her cancer history, the symptoms that HRT helped manage, her family history, and whether staying on HRT was an option. “No doctor I encountered offered to have a discussion about the balance of risk, especially given my [cancer’s] stage,” she says.
