COMMENTARY

How Safe Is Hormone Replacement Therapy After Risk-Reducing Salpingo-oophorectomy in Women With BRCA Mutations?

Maurie Markman, MD

Disclosures

June 14, 2019

This transcript has been edited for clarity.

Hello. I'm Dr Maurie Markman from Cancer Treatment Centers of America in Philadelphia.

I want to very briefly discuss a most interesting review article that appeared in the Journal of Gynecologic Oncology, entitled "Hormone Replacement Therapy After Risk Reducing Salpingo-oophorectomy in Patients With BRCA1 or BRCA2 Mutations; A Systematic Review of Risks and Benefits."[1]

It is very well recognized that risk-reducing salpingo-oophorectomy substantially reduces the lifetime risk for the development of ovarian cancer. The problem is that this will lead to a surgical menopause. In fact, the procedure is performed in premenopausal women, which obviously increases the risks, both from the point of view of quality of life as well as the potential for cardiovascular effects and osteoporosis.

One question that comes up is the potential safety of hormone replacement therapy; the concern here is the potential of increasing the woman's lifetime risk of developing breast cancer. Randomized trials would be difficult to conduct in this setting, considering the risks of hormone replacement therapy versus the potential benefits. But a number of reports, which are outlined in this review article, have described case-control studies that looked at patients who have received hormone monotherapy after the procedure versus those who have not. The data, although limited and certainly not definitive, as outlined in this article, demonstrate that there does not appear to be an overall increased risk for the development of breast cancer beyond that of the baseline in this patient population, suggesting the potential benefit of hormone replacement therapy where indicated in this setting.

This is an important paper, acknowledging the limitations in the existing data. For those doctors—obstetrician-gynecologists, gynecologic oncologists, medical oncologists—who are caring for women considering a risk-reduction salpingo-oophorectomy or who have undergone the procedure and are questioning the potential value of hormone replacement therapy, this review article is very helpful in laying out the risks and benefits and in helping you discuss this very important question with your patients and their families. I encourage you to read this very interesting article. Thank you for your attention.

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