ESTROGEN REPLACEMENT THERAPY IN WOMEN WITH BREAST-CANCER - A SURVEY OF PATIENT ATTITUDES

Estrogen replacement therapy (ERT) is suggested for women with symptomatic estrogen deficiency, but patients with breast cancer are advised against ERT because of concerns that ERT may precipitate cancer recurrence. The attitudes of women with breast cancer regarding ERT is critical in the design of appropriate strategies for the management of their menopause. A randomly selected group of 224 women with breast cancer responded to an anonymous survey that addressed the presence of menopause, antecedent therapies, symptoms related to estrogen deficiency, concerns about osteoporosis or heart disease, attitude about ERT, and perception about ERT-related cancer risk. Among women who completed the survey, 77% were postmenopausal and 81% had had multimodality therapy. Of menopausal women, 27% believed they needed some treatment for menopause and 8% had taken ERT since cancer diagnosis. Most women were afraid that ERT may precipitate cancer recurrence (78%) but they also were concerned about the menopause-related risk of osteoporosis (70%) and heart disease (72%). Overall, 44% of menopausal women were willing to consider ERT under medical supervision. Those treated with surgery alone were distinct in that 71 % would consider ERT (p < 0.04). Premenopausal women were more concerned about osteoporosis (82% vs. 66% for postmenopausal), heart disease (92% vs. 73%), and the possibility that ERT may precipitate cancer recurrence (98% vs. 73%. Yet, at the same time, they were more willing to consider ERT under medical supervision (59% vs. 40% for menopausal). The present study underscores that women with breast cancer are very aware and concerned about the adverse health consequences of estrogen deficiency and would consider ERT under medical supervision. Treatment background, menopausal status, and symptomology affect patient attitudes toward ERT. It will be important to evaluate the role of ERT in the management of menopause in carefully selected women under rigorous medical supervision.