Women Diagnosed With Breast Cancer Should Stop HRT

Laurie Barclay, MD

November 03, 2003

Nov. 3, 2003 — Hormone replacement therapy (HRT) withdrawal at the time of breast cancer diagnosis causes regression of tumors that are estrogen-receptor (ER) positive, according to the results of a study published in the Dec. 15 issue of Cancer and posted online in advance of print on Nov. 3. The study authors emphasize that patients should stop HRT when diagnosed.

"The biologic effect of continuing HRT after a diagnosis of breast carcinoma is unclear," write Ramachandran Prasad, MBBS, from the University Hospital of South Manchester in the UK, and colleagues. "There is ample evidence that estrogens play a role in the tumor promotion."

From 1996 to 2000, Dr. Prasad's team identified 140 women who were taking HRT at the time of diagnosis of breast carcinoma by core-needle biopsy, as well as 55 women diagnosed with breast cancer but not using HRT. Of the 140 women, 125 women stopped HRT when diagnosed, and 15 continued HRT until surgery. The median interval between biopsy and surgery was 17 days (range, 2-31 days).

Of the 125 women who stopped HRT when diagnosed, 106 had ER-positive tumors and 19 had ER-negative tumors. In only the ER-positive tumors, there was a significant decrease between biopsy and surgery in expression of Ki-67, a measure of epithelial cell proliferation (P < .001); of progesterone receptor (P < .001); and of cyclin D1, a stimulator of cell division (P < .001); and an increase in p27 (KIP-21), an anti-tumor protein that normally stops cell division and growth (P = .03).

Although the poor response to tamoxifen in c-erb-B2-positive, ER-positive breast carcinoma suggests that these tumors are hormone resistant, the changes in Ki-67 and progesterone receptor expression in this study occurred independently of c-erb-B2-status.

"This study confirms that ER-positive breast cancer responds to HRT withdrawal and therefore HRT should be discontinued at diagnosis and its subsequent use of HRT in women with ER-positive cancers should be with extreme caution," the authors write.

Cancer. Posted online Nov. 3, 2003.

Reviewed by Gary D. Vogin, MD

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