ICARE Newsletter Winter 2018

Ask the Expert

The following question was addressed by Dr. Ingrid Meszoely is a breast surgeon and Clinical Director of the Vanderbilt Breast Center at One Hundred Oaks. She leads a high-risk clinic, through which she and her team of nurse practitioners manage patients with inherited breast cancer predisposition. Her research interests include both clinical and translational breast cancer-related research.

Q. Is it reasonable to consider hormonal replacement therapy (HRT) in BRCA carriers without breast cancer, after a prophylactic oophorectomy (surgical removal of one or both ovaries)?

A. There have been prior concerns that HRT may raise the risk of breast cancer among BRCA carriers, yet data from multiple studies which have evaluated this question have been reassuring. Specifically, three studies (observational and retrospective studies) have been completed in BRCA mutation carriers without a history of breast cancer, in which HRT did not raise the subsequent risk of breast cancer, nor did it appear to reduce the protective effect of oophorectomy on breast cancer risk.1,2,3 While it would be ideal to confirm these findings through a randomized control trial, data are currently reassuring that HRT is an option that may be considered among BRCA carriers, particularly those with severe menopausal symptoms or other issues that compromise their quality of life. In fact, a recent study on a group of 178 premenopausal women at high risk for ovarian cancer reported that about one third (n=57) opted for risk-reducing salpingo-oophorectomy (RRSO; removal of both ovaries and fallopian tubes).4 Of those with RRSO, 27 used HRT after surgery and 30 did not. HRT users had less menopausal side effects (i.e., endocrine symptoms, sexual symptoms) compared to those with did not use HRT, suggesting the potential benefits of this treatment in the first year following RRSO.

1Eisen, A. et al. J Natl Cancer Inst. 2008 Oct 1;100(19), 1361-7. PMID:18812548.
2Rebbeck, T.R., et al. J Clin Oncol. 2005 Nov 1;23(31), 7804-10. PMID:16219936.
3Kotsopoulos et al. Breast Cancer Res Treat. 2016 Jan;155(2):365-73. PMID:26780555.
4Vermeulen et al. Eur J Cancer. 2017 Oct;84:159-167. PMID: 28818705.

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