Menopausal hormone therapy and breast cancer: risk and management - PubMed
5 days ago
- #menopausal hormone therapy
- #vaginal estrogen
- #breast cancer risk
- Menopausal hormone therapy (MHT) is effective for vasomotor symptoms and genitourinary syndrome of menopause (GSM), but breast cancer risk concerns limit its use.
- Estrogen-alone therapy post-hysterectomy does not increase breast cancer incidence and may reduce mortality.
- Combined estrogen-progestogen therapy has a small, duration-dependent increase in breast cancer risk, with risk varying by progestogen type.
- Micronized progesterone has a more favorable risk profile than synthetic progestins.
- Conjugated estrogens with bazedoxifene improve symptoms and bone density without increasing mammographic density, but long-term oncologic outcomes are unknown.
- In breast cancer survivors, combined estrogen-progestogen therapy and tibolone show harm, while estrogen-alone therapy hasn't been tested in randomized trials.
- Low-dose vaginal estrogen is effective for GSM in most survivors without higher recurrence or mortality risks, though aromatase inhibitor users require shared decision-making.
- Nonhormonal therapies, like neurokinin-3 receptor antagonists, offer alternatives when hormone therapy is contraindicated or declined.
- Individualized counseling, timing, and progestogen selection are key for safe hormone therapy use in healthy women.
- Low-dose vaginal estrogen remains appropriate for refractory GSM in survivors with oncology involvement.