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August 17, 1994, Vol 272, No. 7 >
ARTICLE | August 17, 1994

Estrogen Replacement Therapy in Breast Cancer Survivors: Title and subTitle BreakA Time for Change FREE

Melody A. Cobleigh, MD; Robert F. Berris, MD; Trudy Bush, PhD, MHS; Nancy E. Davidson, MD; Nicholas J. Robert, MD; Joseph A. Sparano, MD; Douglas C. Tormey, MD, PhD; William C. Wood; Robert F. Berris, MD; Melody A. Cobleigh, MD; Nancy E. Davidson, MD; John Fetting, MD; Rebecca S. Gelman, PhD; Donna S. Neuberg, DSc; Kennedy Gilchrist, MD; Lori J. Goldstein, MD; Brenda B. Hopper, MS, ECOG; Lori Hughes, MA; William C. Wood, MD; Krystyna D. Kiel, MD; Worta J. McCaskill-Stevens, MD; George W. Sledge, Jr, MD; Steven Richman, MD; Nicholas J. Robert, MD; Joseph A. Sparano, MD; Thomas J. Smith, MD; Douglas C. Tormey, MD, PhD
[+] Author Affiliations

A list of members of the Eastern Cooperative Oncology Group Breast Cancer Committees appears at the end of the article.

Reprint requests to the Department of Internal Medicine, Division of Hematology/Oncology, Section of Medical Oncology, Rush-Presbyterian-St Luke's Medical Center, Suite 821, Professional Bldg 1, 1725 W Harrison, Chicago, IL 60612 (Dr Cobleigh).


JAMA. 1994;272(7):540-545. doi:10.1001/jama.1994.03520070060039
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References

POSTMENOPAUSAL women often experience annoying and sometimes debilitating menopausal symptoms, and breast cancer survivors are no exception. Hot flashes, dyspareunia, atrophic vaginitis with attendant urinary tract symptoms, sleep disturbance, and mood change are among these symptoms. Coronary artery disease and osteoporosis may be more insidious, but potentially fatal consequences of menopausal estrogen decline. Estrogen replacement therapy (ERT) has been shown to ameliorate these problems,1,2 and as informed consumers, breast cancer survivors are increasingly inquiring about and/or requesting ERT.3

There are more breast cancer survivors alive now than ever before, so their nononcologic health problems are a growing concern. A dramatic rise in the incidence rates of breast cancer occurred in the United States between 1982 and 1987, presumably because of increased screening.4 The incidence of noninvasive and of small, invasive, axillary nodenegative breast cancers rose concurrently.4 Five-year survival rates for breast cancer patients also have been

REFERENCES

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American College of Obstetricians and Gynecologists. Hormone Replacement Therapy . Washington, DC: American College of Obstetricians and Gynecologists; April 1992;:166.
2 +
Wiklund I, Holst J, Karlberg J, et al.  A new methodological approach to the evaluation of quality of life in postmenopausal women. Maturitas . 1992;;14:211-224.
3 +
Wile AG, Opfell RW, Margileth DA.  Hormone replacement therapy in previously treated breast cancer patients. Am J Surg . 1993;;165:372-375.
4 +
Miller BA, Feuer EJ, Hankey BF, et al.  Recent incidence trends for breast cancer in women and the relevance of early detection: an update. CA Can J Clin . 1993;;43:27-41.
5 +
Grady D, Rubin SM, Petitti DB, et al.  Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med . 1992;;15:1016-1037.
6 +
Fisher B, Costantino J, Redmond C, et al.  A randomized clinical trial evaluating tamoxifen in the treatment of patients with node-negative breast cancer who have estrogen receptor—positive tumors. N Engl J Med 1989;;320:479-484.
7 +
Mansour EG, Gray R, Shatila AH, et al.  Efficacy of adjuvant chemotherapy in high-risk node-negative breast cancer. N Engl J Med . 1989;;320:485-490.
8 +
The Ludwig Breast Cancer Study Group.  Prolonged disease-free survival after one course of perioperative adjuvant chemotherapy for node-negative breast cancer. N Engl J Med . 1989;;320:491-496.
9 +
Fisher B, Redmond C, Dimitrov NV, et al.  A randomized trial evaluating sequential methotrexate and fluorouracil in the treatment of patients with node-negative breast cancer who have estrogen-receptor-negative tumors. N Engl J Med . 1989;; 320:474-478.
10 +
Mehta RR, Beattie CW, Das Gupta T.  Endocrine profile in breast cancer patients receiving chemotherapy. Breast Cancer Res Treat . 1991;;20:125-132.
11 +
Bonadonna G, Valagussa P, Rossi A, et al.  CMF adjuvant chemotherapy in operable breast cancer.  In: Jones SE, Salmon SS, eds. Adjuvant Therapy of Cancer II . New York, NY: Grune & Stratton Inc; 1979;:227-235.
12 +
Barrett-Connor E, Bush TL.  Estrogen and coronary heart disease in women. JAMA . 1991;;265:1861-1867.
13 +
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14 +
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15 +
Merill JM.  Estrogen replacement therapy after breast cancer. JAMA . 1992;;267:568.
16 +
Creasman WT.  Estrogen replacement therapy: is previously treated cancer a contraindication? Obstet Gynecol . 1991;;77:308-311.
17 +
Hutchinson-Williams KA.  Estrogen replacement therapy (ERT) in high-risk cancer patients. Yale J Biol Med . 1991;;64:607-626.
18 +
Theriault RL, Sellin RV.  A clinical dilemma: estrogen replacement therapy in postmenopausal women with a background of primary breast cancer. Ann Oncol . 1991;;2:709-717.
19 +
Davidson JA.  The need for a randomized trial of hormone replacement therapy in women with breast cancer. Med J Aust . 1991;;157:429.
20 +
DiSaia PJ.  Hormone replacement therapy in patients with breast cancer: a reappraisal. Cancer . 1993;;71( (suppl 4) ):1490-1500.
21 +
Henderson IC.  Risk factors for development of breast cancer. Cancer . 1993;;71( (suppl) ):2127-2140.
22 +
Eden JA.  Oestrogen and the breast, 1: myths about oestrogen and breast cancer. Med J Aust . 1992;;157:175-176.
23 +
Powles TJ.  Treatment of menopausal symptoms in breast cancer patients. Lancet . 1988;;2:344-345.
24 +
Stoll BA, Parbhoo S.  Treatment of menopausal symptoms in breast cancer patients. Lancet . 1988;; 1:1278-1279.
25 +
Marchant DJ.  Estrogen-replacement therapy after breast cancer. Cancer . 1993;;71:2169-2176.
26 +
Eden JA.  Oestrogen and the breast, 2: the management of the menopausal woman with breast cancer. Med J Aust . 1992;;157:247-250.
27 +
Stoll BA.  Hormone replacement therapy in women treated for breast cancer. Eur J Cancer Clin Oncol . 1989;;25:1909.
28 +
American College of Physicians.  Guidelines for counseling postmenopausal women about preventive hormone therapy. Ann Intern Med . 1992;;117: 1038-1041.
29 +
Berkowitz JE, Gatewood OM, Goldblum LE, Gayler BW.  Hormonal replacement therapy: mammographic manifestations. Radiology . 1990;;174:199-201.
30 +
Kaufman Z, Garstin WI, Hayes R, Michell MJ, Baum M.  The mammographic parenchymal patterns of women on hormonal replacement therapy. Clin Radiol . 1991;;43:389-392.
31 +
Bland KI, Buchanan JB, Weisberg BF, Hagen TA, Gray LA.  The effects of exogenous estrogen replacement therapy of the breast: breast cancer risk and mammographic parenchymal patterns. Cancer . 1980;;45:3027-3033.
32 +
Stomper PC, Van Voorhis BJ, Ravnikar VA, Meyer JE.  Mammographic changes associated with postmenopausal hormone replacement therapy: a longitudinal study. Radiology . 1990;;174:487-490.
33 +
Kelsey JL, Berkowitz GS.  Breast cancer epidemiology. Cancer Res . 1988;;48:5615-5623.
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Harvey EB, Brinton LA.  Second cancer following cancer of the breast in Connecticut, 1935-1982. Natl Cancer Inst Monogr . 1985;;68:99-112.
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Hunt K, Vessey M, McPherson K, Coleman M.  Long-term surveillance of mortality and cancer incidence in women receiving hormone replacement therapy. Br J Obstet Gynaecol . 1987;;94:620-635.
36 +
Palmer JR, Rosenbert L, Clarke EA, Shapiro S.  Breast cancer risk after estrogen replacement therapy: results from the Toronto Breast Cancer Society. Am J Epidemiol . 1991;;134:1386-1395.
37 +
DuPont WD, Page DL, Rogers LW, Parl FF.  Influence of exogenous estrogens, proliferative breast disease and other variables on breast cancer risk. Cancer . 1989;;643:948-957.
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Brownson RC, Blackwell CW, Pearson DK, Reynolds RD, Richens JW, Papermaster BW.  Risk of breast cancer relation to cigarette smoking. Arch Intern Med . 1988;;148:140-144.
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Rohan TE, McMichael AJ.  Non-contraceptive exogenous oestrogen therapy and breast cancer. Med J Aust . 1988;;148:217-221.
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97 +
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98 +
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101 +
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103 +
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104 +
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105 +
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106 +
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107 +
Eden JA, Bush T, Nand S, Wren BG.  The Royal Hospital for Women Breast Cancer Study: a case-controlled study of combined continuous hormone replacement therapy amongst women with a personal history of breast cancer. Med J Aust . In press.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
American College of Obstetricians and Gynecologists. Hormone Replacement Therapy . Washington, DC: American College of Obstetricians and Gynecologists; April 1992;:166.
2 +
Wiklund I, Holst J, Karlberg J, et al.  A new methodological approach to the evaluation of quality of life in postmenopausal women. Maturitas . 1992;;14:211-224.
3 +
Wile AG, Opfell RW, Margileth DA.  Hormone replacement therapy in previously treated breast cancer patients. Am J Surg . 1993;;165:372-375.
4 +
Miller BA, Feuer EJ, Hankey BF, et al.  Recent incidence trends for breast cancer in women and the relevance of early detection: an update. CA Can J Clin . 1993;;43:27-41.
5 +
Grady D, Rubin SM, Petitti DB, et al.  Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med . 1992;;15:1016-1037.
6 +
Fisher B, Costantino J, Redmond C, et al.  A randomized clinical trial evaluating tamoxifen in the treatment of patients with node-negative breast cancer who have estrogen receptor—positive tumors. N Engl J Med 1989;;320:479-484.
7 +
Mansour EG, Gray R, Shatila AH, et al.  Efficacy of adjuvant chemotherapy in high-risk node-negative breast cancer. N Engl J Med . 1989;;320:485-490.
8 +
The Ludwig Breast Cancer Study Group.  Prolonged disease-free survival after one course of perioperative adjuvant chemotherapy for node-negative breast cancer. N Engl J Med . 1989;;320:491-496.
9 +
Fisher B, Redmond C, Dimitrov NV, et al.  A randomized trial evaluating sequential methotrexate and fluorouracil in the treatment of patients with node-negative breast cancer who have estrogen-receptor-negative tumors. N Engl J Med . 1989;; 320:474-478.
10 +
Mehta RR, Beattie CW, Das Gupta T.  Endocrine profile in breast cancer patients receiving chemotherapy. Breast Cancer Res Treat . 1991;;20:125-132.
11 +
Bonadonna G, Valagussa P, Rossi A, et al.  CMF adjuvant chemotherapy in operable breast cancer.  In: Jones SE, Salmon SS, eds. Adjuvant Therapy of Cancer II . New York, NY: Grune & Stratton Inc; 1979;:227-235.
12 +
Barrett-Connor E, Bush TL.  Estrogen and coronary heart disease in women. JAMA . 1991;;265:1861-1867.
13 +
Stampfer MJ, Colditz GA, Willett WC, et al.  Postmenopausal estrogen therapy and cardiovascular disease: 10-year follow-up from the Nurses' Health Study. N Engl J Med . 1991;;325:756-762.
14 +
Rosen PP, Groshen S, Kinne DW, Norton L.  Factors influencing prognosis in node-negative breast carcinoma: analysis of 767 T1N0M0/T2N0M0 patients with long-term follow-up. J Clin Oncol . 1993;;1:2090-2100.
15 +
Merill JM.  Estrogen replacement therapy after breast cancer. JAMA . 1992;;267:568.
16 +
Creasman WT.  Estrogen replacement therapy: is previously treated cancer a contraindication? Obstet Gynecol . 1991;;77:308-311.
17 +
Hutchinson-Williams KA.  Estrogen replacement therapy (ERT) in high-risk cancer patients. Yale J Biol Med . 1991;;64:607-626.
18 +
Theriault RL, Sellin RV.  A clinical dilemma: estrogen replacement therapy in postmenopausal women with a background of primary breast cancer. Ann Oncol . 1991;;2:709-717.
19 +
Davidson JA.  The need for a randomized trial of hormone replacement therapy in women with breast cancer. Med J Aust . 1991;;157:429.
20 +
DiSaia PJ.  Hormone replacement therapy in patients with breast cancer: a reappraisal. Cancer . 1993;;71( (suppl 4) ):1490-1500.
21 +
Henderson IC.  Risk factors for development of breast cancer. Cancer . 1993;;71( (suppl) ):2127-2140.
22 +
Eden JA.  Oestrogen and the breast, 1: myths about oestrogen and breast cancer. Med J Aust . 1992;;157:175-176.
23 +
Powles TJ.  Treatment of menopausal symptoms in breast cancer patients. Lancet . 1988;;2:344-345.
24 +
Stoll BA, Parbhoo S.  Treatment of menopausal symptoms in breast cancer patients. Lancet . 1988;; 1:1278-1279.
25 +
Marchant DJ.  Estrogen-replacement therapy after breast cancer. Cancer . 1993;;71:2169-2176.
26 +
Eden JA.  Oestrogen and the breast, 2: the management of the menopausal woman with breast cancer. Med J Aust . 1992;;157:247-250.
27 +
Stoll BA.  Hormone replacement therapy in women treated for breast cancer. Eur J Cancer Clin Oncol . 1989;;25:1909.
28 +
American College of Physicians.  Guidelines for counseling postmenopausal women about preventive hormone therapy. Ann Intern Med . 1992;;117: 1038-1041.
29 +
Berkowitz JE, Gatewood OM, Goldblum LE, Gayler BW.  Hormonal replacement therapy: mammographic manifestations. Radiology . 1990;;174:199-201.
30 +
Kaufman Z, Garstin WI, Hayes R, Michell MJ, Baum M.  The mammographic parenchymal patterns of women on hormonal replacement therapy. Clin Radiol . 1991;;43:389-392.
31 +
Bland KI, Buchanan JB, Weisberg BF, Hagen TA, Gray LA.  The effects of exogenous estrogen replacement therapy of the breast: breast cancer risk and mammographic parenchymal patterns. Cancer . 1980;;45:3027-3033.
32 +
Stomper PC, Van Voorhis BJ, Ravnikar VA, Meyer JE.  Mammographic changes associated with postmenopausal hormone replacement therapy: a longitudinal study. Radiology . 1990;;174:487-490.
33 +
Kelsey JL, Berkowitz GS.  Breast cancer epidemiology. Cancer Res . 1988;;48:5615-5623.
34 +
Harvey EB, Brinton LA.  Second cancer following cancer of the breast in Connecticut, 1935-1982. Natl Cancer Inst Monogr . 1985;;68:99-112.
35 +
Hunt K, Vessey M, McPherson K, Coleman M.  Long-term surveillance of mortality and cancer incidence in women receiving hormone replacement therapy. Br J Obstet Gynaecol . 1987;;94:620-635.
36 +
Palmer JR, Rosenbert L, Clarke EA, Shapiro S.  Breast cancer risk after estrogen replacement therapy: results from the Toronto Breast Cancer Society. Am J Epidemiol . 1991;;134:1386-1395.
37 +
DuPont WD, Page DL, Rogers LW, Parl FF.  Influence of exogenous estrogens, proliferative breast disease and other variables on breast cancer risk. Cancer . 1989;;643:948-957.
38 +
Brownson RC, Blackwell CW, Pearson DK, Reynolds RD, Richens JW, Papermaster BW.  Risk of breast cancer relation to cigarette smoking. Arch Intern Med . 1988;;148:140-144.
39 +
Rohan TE, McMichael AJ.  Non-contraceptive exogenous oestrogen therapy and breast cancer. Med J Aust . 1988;;148:217-221.
40 +
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