Managing Menopause with Inherited Risk of Breast Cancer
By Sue Friedman and Drea Thew
Presented at the 2006 Joining FORCEs Conference by Noah Kauff, MD, Clinical Genetics and Gynecology Services, Memorial Sloan-Kettering Cancer Center
Dr. Kauff discussed findings from the much publicized Women’s Health Initiative (WHI) study on hormone replacement therapy (HRT) in post-menopausal women:
- The WHI study was stopped early when participants who were taking HRT (estrogen plus progestin) had an increased incidence of breast cancer.
- The HRT study group also had significant increases in other diseases, such as coronary heart disease, stroke and pulmonary embolism.
- The estrogen-only arm of the study (women with no uterus) showed no statistically significant change in breast cancer or coronary heart disease over women on placebo.
Conclusions drawn from the study included:
- HRT in naturally post-menopausal women should be used at the lowest dose for the shortest period of time to relieve symptoms.
- HRT should not be given to asymptomatic women who are 60 or older to prevent chronic disease.
The WHI study focused on women of average breast cancer risk who went through natural menopause. Dr. Kauff emphasized that it is unclear whether the results apply to high-risk women in their 30s and 40s who experienced surgical menopause.
Dr. Kauff explained data from other studies regarding HRT including:
- HRT safety is questionable for women with a history of hormonereceptor-positive breast cancer
- Good evidence shows HRT after ovarian cancer does not affect survival.
- HRT may be reasonable for BRCA carriers who haven’t had breast cancer or whose breast cancer was hormonereceptor-negative after careful discussion of risks and benefi ts.
- One study found a 60 percent reduction in breast cancer risk among BRCA1/2 carriers who had oophorectomy, even when they also took short-term HRT.
Dr. Kauff introduced some non-hormonal options for managing menopausal symptoms:
- Selective serotonin reuptake inhibitors (SSRIs), commonly prescribed as anti-depressants, effectively treat hot flashes in 60-70 percent of women and likely have no impact on breast cancer risk.
- Non-medical interventions such as paced respirations and aerobic exercise can help mitigate menopausal symptoms.
- Water-based lubricants and Vitamin E-based moisturizers can improve vaginal dryness. If vaginal lubricants are ineffective, low-dose vaginal estrogen may help. Vaginal estrogens increase estrogen levels slightly and should be used only after weighing the benefits and the risks.
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