04/22/2026
๐๐จ๐ซ๐ฆ๐จ๐ง๐ ๐๐๐ฉ๐ฅ๐๐๐๐ฆ๐๐ง๐ญ ๐๐ก๐๐ซ๐๐ฉ๐ฒ ๐๐๐ญ๐๐ซ ๐๐ซ๐๐๐ฌ๐ญ ๐๐๐ง๐๐๐ซ: There are real risks to denying this care to breast cancer survivors.
Use of menopausal hormone therapy (HT) fell precipitously after 2002, largely as a result of the Women's Health Initiative's report claiming that the combination of conjugated equine estrogen (CEE) and medroxyprogesterone acetate increased breast cancer risk and did not improve quality of life (two drugs we shouldn't really be reaching for first).
A generation of women has been deprived of HT largely as a result of this ๐ฐ๐ข๐๐๐ฅ๐ฒ ๐ฉ๐ฎ๐๐ฅ๐ข๐๐ข๐ณ๐๐ ๐ฆ๐ข๐ฌ๐ข๐ง๐ญ๐๐ซ๐ฉ๐ซ๐๐ญ๐๐ญ๐ข๐จ๐ง ๐จ๐ ๐ญ๐ก๐ ๐๐๐ญ๐. This article attempts to rectify this misunderstanding, with the goal of helping patients and physicians make informed joint decisions about the use of HT. [1]
Twenty-five studies of HRT after a breast cancer diagnosis, published... Only 1 of the 25 studies, the HABITS trial, demonstrated an increased risk of recurrence, which was limited to local or contralateral, and not distant, recurrence. "๐๐จ๐ง๐ ๐จ๐ ๐ญ๐ก๐ ๐ฌ๐ญ๐ฎ๐๐ข๐๐ฌ, ๐ข๐ง๐๐ฅ๐ฎ๐๐ข๐ง๐ ๐๐๐๐๐๐, ๐ซ๐๐ฉ๐จ๐ซ๐ญ๐๐ ๐ข๐ง๐๐ซ๐๐๐ฌ๐๐ ๐๐ซ๐๐๐ฌ๐ญ ๐๐๐ง๐๐๐ซ ๐ฆ๐จ๐ซ๐ญ๐๐ฅ๐ข๐ญ๐ฒ ๐๐ฌ๐ฌ๐จ๐๐ข๐๐ญ๐๐ ๐ฐ๐ข๐ญ๐ก ๐๐๐." [2] Zero!!
"Based on the available data, we recommend that shared decisions are based on (1) an individual's menopausal symptoms and impact on quality of life, (2) the potential increase in an individual's risk of relapse by use of menopausal hormone therapy, and (3) patient preferences, views and treatment goals. ๐๐ฅ๐ข๐ง๐ข๐๐ข๐๐ง๐ฌ ๐๐ง๐ ๐ฉ๐๐ญ๐ข๐๐ง๐ญ๐ฌ ๐๐๐ง ๐ฎ๐ฌ๐ ๐จ๐ฎ๐ซ ๐๐ข๐ง๐๐ข๐ง๐ ๐ฌ ๐ญ๐จ ๐ฆ๐๐ค๐ ๐ข๐ง๐๐จ๐ซ๐ฆ๐๐ ๐ฆ๐๐ง๐จ๐ฉ๐๐ฎ๐ฌ๐ ๐ญ๐ซ๐๐๐ญ๐ฆ๐๐ง๐ญ ๐๐ก๐จ๐ข๐๐๐ฌ ๐๐๐ญ๐๐ซ ๐๐ซ๐๐๐ฌ๐ญ ๐๐๐ง๐๐๐ซ." [3]
"Conclusions and Relevance: ๐๐๐ฌ๐ฎ๐ฅ๐ญ๐ฌ ๐จ๐ ๐ญ๐ก๐ข๐ฌ ๐ฌ๐ญ๐ฎ๐๐ฒ ๐ฌ๐ก๐จ๐ฐ๐๐ ๐ง๐จ ๐๐ฏ๐ข๐๐๐ง๐๐ ๐จ๐ ๐ข๐ง๐๐ซ๐๐๐ฌ๐๐ ๐๐๐ซ๐ฅ๐ฒ ๐๐ซ๐๐๐ฌ๐ญ ๐๐๐ง๐๐๐ซ-๐ฌ๐ฉ๐๐๐ข๐๐ข๐ ๐ฆ๐จ๐ซ๐ญ๐๐ฅ๐ข๐ญ๐ฒ ๐ข๐ง ๐ฉ๐๐ญ๐ข๐๐ง๐ญ๐ฌ ๐ฐ๐ก๐จ ๐ฎ๐ฌ๐๐ ๐ฏ๐๐ ๐ข๐ง๐๐ฅ ๐๐ฌ๐ญ๐ซ๐จ๐ ๐๐ง ๐ญ๐ก๐๐ซ๐๐ฉ๐ฒ ๐๐จ๐ฆ๐ฉ๐๐ซ๐๐ ๐ฐ๐ข๐ญ๐ก ๐ฉ๐๐ญ๐ข๐๐ง๐ญ๐ฌ ๐ฐ๐ก๐จ ๐๐ข๐ ๐ง๐จ๐ญ ๐ฎ๐ฌ๐ ๐๐๐. This finding may provide some reassurance to prescribing clinicians and support the guidelines suggesting that vaginal estrogen therapy can be considered in patients with breast cancer and genitourinary symptoms." [4]
AND, cardiovascular/heart-specific death is higher in breast cancer patients than the general population and withholding estradiol exacerbates this.
"The risk of heart-specific death is significantly higher in breast cancer patients than in the general population and closely related to demographic characteristics and tumor clinicopathological factors. Medical approaches are needed to reduce the risk of heart disease among patients with breast cancer." [5]
Withholding care is not benign or without significant risk which is often not discussed, or weighed.
Cited:
1) Bluming AZ, Hodis HN, Langer RD. โTis but a scratch: a critical review of the Womenโs Health Initiative evidence associating menopausal hormone therapy with the risk of breast cancer. Menopause. 2023;30(12):1241-1245.
2) Bluming AZ. Hormone Replacement Therapy After Breast Cancer: It Is Time. Cancer J. 2022;28(3):183-190.
3) Glynne S, Simon J, Branson A, et al. Menopausal hormone therapy for breast cancer patients: what is the current evidence? Menopause. 2026;33(1):88-117.
4) McVicker L, Labeit AM, Coupland CAC, et al. Vaginal estrogen therapy use and survival in females with breast cancer. JAMA Oncol. 2024;10(1):103-108.
5) Luo Y, Zhao et al. The risk of heart-specific death in breast cancer patients. Sci Rep. 2025 Aug 2;15(1):28228. .
