ICARE Newsletter Spring 2024

Ask the Expert

This question was addressed by Ronald D. Alvarez, MD, MBA, Professor and Chairman of the Department of Obstetrics and Gynecology at the Vanderbilt University Medical Center in Nashville, Tennessee. He is also the current vice chair of the National Comprehensive Cancer Network (NCCN) Ovarian Cancer Treatment Guidelines and has served in multiple leadership roles in both national and international organizations in various capacities. If you have a question you would like addressed, email ICARE@vumc.org for consideration in future newsletters.

Q: I am 40 years old with a BRCA1 mutation and no history of cancer. I had my ovaries preventively removed last year at the recommendation of my doctor, but now I am having severe symptoms from menopause. Is hormone replacement treatment (HRT) an option for me, and would this further raise my risk of breast cancer?

A: HRT should be considered in women without a history of breast cancer who go into menopause prematurely due to preventive removal of their ovaries and do not have any other reasons they should not take HRT. In fact, premature menopause can be harmful to bone, cardiovascular, psychosocial, neurologic, and sexual health, as well as generalized quality-of-life, and HRT can reduce these side effects. It is important to discuss menopausal management with a gynecologist or other qualified healthcare professional with expertise in this area, as recently outlined in the NCCN Familial/Genetic Breast, Ovarian and Pancreatic Cancer Guidelines, Version 3.2024.

While there has historically been concern that HRT may raise the risk of breast cancer among those already at higher risk for breast cancer (e.g., BRCA1 and BRCA2 (BRCA) carriers), findings through observational and retrospective studies are reassuring. Specifically, research studies have not shown that BRCA carriers without a history of breast cancer who are given HRT had a higher risk for breast cancer.1-3 Furthermore, studies have shown that HRT use in BRCA carriers may reduce the side effects from menopause,4 similar to that observed in the general population.5 Therefore, while it would be ideal to confirm these findings through a randomized clinical trial, current information is reassuring that HRT does not raise breast cancer risk in BRCA carriers.6

1Rebbeck, et al. J Clin Oncol. 2005;23(31):7804-10. PMID:16219936;

2Eisen, et al. J Natl Cancer Inst. 2008;100(19):1361-7. PMID:18812548;

3Kotsopoulos, et al. Breast Cancer Res Treat. 2016;155(2):365-73. PMID:26780555.;

4Vermeulen et al. Eur J Cancer. 2017;84:159-167. PMID:28818705;

5Mielke, et al. Menopause. 2023;30(11):1090-1097. PMID:37699239;

6Chlebowski RT, Prentice RL. J Natl Cancer Inst. 2008;100(19):1341-3. PMID:18812547.

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