Dr. Brian Lawenda

11/14/2025

🚴‍♂️ Finished a HIIT bike session this AM and here’s why it matters beyond fitness.

A new study published in Breast Cancer Research and Treatment (https://link.springer.com/article/10.1007/s10549-025-07772-w) looked at breast-cancer survivors and found something compelling: a single bout of high-intensity interval training (HIIT) or resistance training significantly increased anti-cancer myokines (muscle-secreted proteins) and reduced the growth of a breast-cancer cell line by about 20–30%.

More about HIIT: https://en.wikipedia.org/wiki/High-intensity_interval_training

Here are the key takeaways:

📍 Myokines surged 9–47% after a single workout.
📍 Cancer-cell growth in vitro dropped 19–29% after HIIT and ~20–21% after resistance training, with HIIT showing the strongest immediate effect.

The study applied just one 45-minute session of RT or HIIT to 32 breast-cancer survivors (16 per group) and measured blood samples before exercise, immediately after, and 30 minutes later.

A quick explanation of the “in vitro” part (in simple terms):

Researchers didn’t test exercise on real tumors. Instead, they:
1. had survivors do a HIIT workout,
2. took their blood before and after, and
3. put that blood on breast-cancer cells growing in a lab dish.

Blood collected after HIIT slowed cancer-cell growth by up to 30% in this controlled lab model.
This doesn’t mean HIIT directly shrinks tumors in the body, but it does show that exercise immediately changes your blood chemistry in ways that make cancer cells less likely to grow.

So when you finish a HIIT session, know that it’s more than just sweat and speed, you’re activating muscle as medicine. Even short, intense sessions can trigger biological processes that may help create a physiology less hospitable to cancer.

If you’ve been asking how exercise “actually fights cancer” instead of just “helps you get in shape,” this is one of the clearest mechanistic links we have.

11/13/2025

I was truly honored to serve as the guest speaker this evening at the American Cancer Society’s Hope & Honors — A Night to Remember.

This remarkable group of donors came together with one shared purpose: to support patients and families facing cancer. Their generosity raised an incredible $300,000 for the ACS. Seeing that level of commitment and compassion in one room was inspiring. 🙌🏻

Grateful for the opportunity to speak, to share stories of hope, and to witness the power of a community that refuses to stand still in the fight against cancer.

11/11/2025

It’s Dark, Cold, and Early… Move Anyway (or Whenever You Can).

This morning I was up at 4:00 a.m. — coffee, a 45-minute workout, shower, and off to clinic. And yes, it’s actually cold here in Florida — the kind of rare “30s” cold where the weather alerts warn about iguanas falling out of trees. (See my comment below for our weatherman post on the iguanas 🦎)

Now, I don’t get up early because I enjoy it — I do it because if I wait until the end of the day, it just won’t happen. But that’s me. You don’t need to be a 4 a.m. workout person. The best time to exercise is whenever it actually fits your life.

You can break it up — a 10-minute walk after each meal, a few sets of squats or push-ups between meetings, a brisk bike ride with the kids, or resistance bands at home. It all adds up. You don’t need a fancy gym, and you don’t have to do it every single day. Consistency over time is what counts.

Here’s what the science says:
• 150–300 minutes of moderate aerobic exercise per week (or 75–150 minutes of vigorous activity) lowers your risk of cardiovascular disease and early death by 25–30%.
• Add two strength-training sessions per week, and your risk of death from any cause drops another 10–20% — including lower rates of heart disease, cancer, and diabetes.
• Regular movement keeps your brain sharp and lowers dementia risk, even if you’re just walking most days.
• And on a cellular level, exercise reduces inflammation, strengthens your immune system, improves insulin sensitivity, and helps preserve muscle mass and metabolism as you age.

You don’t have to be perfect — just consistent. You don’t need a gym — just gravity. And you don’t need to do it all at once — just move a little more, a little often.

So tomorrow, when it’s dark and you’re tempted to hit snooze, or later in the day when you finally have 10 free minutes — take them. Move your body. Your heart, brain, and future self will thank you.
(And if you’re in Florida… watch out for falling iguanas on the way.)

11/10/2025

No. We’re not related. 😜

To the Wallenda Family, thank you for making Sarasota your home.
Nick Wallenda starting his world record walk, with his sister, at UTC on 11.6.25. Photo: Eilyn, thank you!

11/10/2025

A few months ago we got big news in breast cancer care: smarter, not harsher

A major 2025 study in The New England Journal of Medicine called NSABP B-51 is changing how doctors think about radiation after chemotherapy.

For years, anyone whose breast cancer had spread to lymph nodes was almost certain to need radiation after surgery. But this new study found that some people whose chemotherapy completely cleared their lymph nodes might not need radiation if they meet very specific medical criteria.

This is not a “no more radiation” story. It is a sign that care is becoming more personalized and precise. The goal is to tailor treatment to each individual, reducing side effects for some while maintaining excellent outcomes for all.

It is a big step forward in creating more compassionate, evidence-based cancer care that uses radiation only when it truly helps.

Learn what this means for patients in 2025 👇
🔗

My two cents

11/08/2025

You may have heard recent news headlines indicating that there's no benefit for radiation therapy after mastectomy. These headlines have sensationalized a recent study called SUPREMO, which looked at the use of radiation therapy after mastectomy in a particular population of breast cancer patients investigating whether there would be a benefit with or without radiation therapy after mastectomy.

These are my two cents, and why I think the study does not change the standard of care for patients who still have a risk that is not insignificant of additional metastatic disease within the axillary lymph nodes.

My two cents.

11/05/2025

Everyone wants a magic pill 💊 to lower cancer risks and improve cancer outcomes. If exercise was an anticancer drug it would be worth $$ Billions.

10/18/2025

🩸 Why the Galleri® Multi-Cancer Early Detection Test Is Worth Considering

Most of today’s cancer screening focuses on just a few cancers — breast, colon, cervix, prostate, and lung (for smokers).
💥But here’s the problem: around 70% of cancer deaths come from cancers that don’t have any standard screening tests.

That’s where Galleri® comes in.
It’s a simple blood test that looks for tiny fragments of tumor DNA circulating in your bloodstream.
When combined with regular screenings, it can dramatically improve your odds of finding cancer early — when it’s most treatable.

Here’s what the latest PATHFINDER 2 study (ESMO 2025) found:
✅ 7× more cancers detected when Galleri was added to standard screenings 🔥
✅ Over half were caught in stage I–II (often curable).
✅ About 3 in 4 detected cancers have no existing screening test.
✅ Accuracy: 99.6% specificity (only 0.4% false positives).
✅ Pinpoint precision: correctly identified the cancer’s location 92% of the time.

Early detection doesn’t just save lives — it can mean less aggressive treatment, fewer complications, and a better quality of life.

📍Bottom line:
If you’re 50 or older — or have a higher-than-average cancer risk — adding Galleri to your regular screening routine could be one of the most proactive health decisions you ever make.

10/07/2025

For decades, breast cancer survivors have faced a cruel dilemma. Many endure the painful and intimate consequences of menopause—dryness, burning, painful intimacy, recurrent urinary infections—yet are warned to avoid the most effective therapy: vaginal estrogen.

The reasoning seemed straightforward. If breast tumors feed on estrogen, then surely any estrogen, even the tiny amounts absorbed from a local vaginal cream or tablet, could fan the embers of cancer. Better to suffer than to risk a recurrence—that was the message survivors often heard from their doctors.

But what if that assumption was never fully grounded in evidence?

A systematic review and meta-analysis published in the American Journal of Obstetrics and Gynecology challenges the dogma. Researchers pooled data from nearly 60,000 breast cancer survivors, including almost 6,000 who used vaginal estrogen. https://www.ajog.org/article/S0002-9378(24)01126-8/fulltext

💥Their findings were striking in their reassurance: there was no evidence that vaginal estrogen increases the risk of breast cancer recurrence, breast cancer–specific mortality, or overall mortality.

💥In fact, the odds of recurrence were actually numerically lower in women who used vaginal estrogen—a finding that should not be overinterpreted, but one that adds to a growing body of literature suggesting that our long-held fears may have been misplaced.

⸻

A Long-Standing Clinical Paradox

As a radiation oncologist, I see this paradox play out almost daily. A woman who has endured surgery, chemotherapy, radiation, and often years of hormone-blocking therapy comes to clinic with tears in her eyes, describing the loss of intimacy, the constant burning, the way her body no longer feels like her own. She has survived breast cancer, but her survivorship is marred by suffering that is both invisible and stigmatized.

Non-hormonal lubricants and moisturizers, while helpful for some, often fall short. Vaginal estrogen, in contrast, is remarkably effective. Yet until now, many oncologists have hesitated to endorse it, fearing we might be trading symptom relief for an increased risk of recurrence.

This new analysis provides a much-needed measure of clarity.

⸻

What the Evidence Shows

The research team combed through major medical databases and identified eight studies with rigorous criteria, ultimately analyzing outcomes for 59,724 women. Among them, 5,795 used vaginal estrogen.
📍Recurrence: No increased risk. Pooled data showed a 52% reduction in recurrence odds, though this result should be viewed with caution given the observational nature of the studies.
📍Breast cancer–specific mortality: No increase.
📍Overall mortality: No increase.

💥Taken together, the data suggest that for most survivors, vaginal estrogen does not pose the risk we long feared.

⸻

Important Caveats

These findings, while reassuring, are not the final word. All the included studies were observational, not randomized controlled trials. That means women who were prescribed vaginal estrogen may have been healthier, lower-risk, or better monitored than those who weren’t—a bias that can tilt results.

There is also variability in formulations, doses, and duration of use. Some women may have used vaginal estrogen only briefly, and most studies did not stratify results by whether patients were on aromatase inhibitors or tamoxifen—important distinctions when considering estrogen metabolism and absorption.

So while this study strengthens the case for safety, it does not prove it beyond all doubt.

⸻

What It Means for Patients

For breast cancer survivors living with the distress of genitourinary syndrome of menopause, this meta-analysis should open doors to new, more balanced conversations with their care teams. Survivors deserve more than blanket prohibitions. They deserve individualized discussions that weigh quality of life alongside recurrence risk, grounded in the best evidence available.

I would not argue that vaginal estrogen is appropriate for every woman. But I do believe that denying it reflexively is no longer defensible.

Quality of life is not a luxury—it is part of survival. If we have treatments that can safely restore dignity, intimacy, and comfort to breast cancer survivors, we owe it to them to use the evidence to guide us, not our fears.

10/04/2025

🚨 Radiation vs Surgery in Early Lung Cancer — The 10-Year Evidence is In

The updated STARS trial just reported 10-year outcomes directly comparing surgery vs stereotactic body radiation therapy (SBRT/SABR) for operable stage I lung cancer. https://amportal.astro.org/sessions/ss-29-21601/ten-year-outcomes-of-the-revised-stars-trial-comparing-radiation-and-surgery-for-early-stage-106737

📊 Key Results
•10-year overall survival: 69% with SABR vs 66% with surgery
•7-year overall survival: 81% SABR vs 70% surgery
•Lung cancer-specific survival at 10 years: ~92% SABR vs ~89% surgery
•Recurrence-free survival at 10 years: 57% SABR vs 65% surgery
•Toxicity: Only ~1% of SABR patients had moderate-to-severe side effects, compared with ~50% of surgical patients
•Bronchoscopic staging: 100% of patients had proper bronchoscopic lymph node staging upfront before treatment, ensuring a fair comparison

💡 What This Means

SABR is a non-invasive, outpatient treatment delivered in just 1–5 sessions, with patients going home the same day. Survival is at least as good as surgery, but with far fewer complications and better quality-of-life potential.

And this isn’t just one study. Multiple analyses and smaller trials have shown the same pattern: SBRT is as effective as surgery in early lung cancer, especially when factoring in toxicity, recovery, and quality of life.

👉 The VALOR trial (ongoing in the VA system) is the first large randomized study designed to settle this question once and for all.

⚖️ The Problem

Despite mounting evidence, current guidelines still call surgery the “preferred” option. But the science now shows clearly:
🔥SBRT is not second best — it’s an equally effective choice.

Patients deserve to know they have options.

Long-term data from the STARS trial affirm stereotactic radiation as a strong alternative to surgery for patients with operable stage I NSCLC.

09/29/2025

The Menopause Scare That Never Should Have Happened

I was a radiation oncology resident at Massachusetts General Hospital in the summer of 2002 when the Women’s Health Initiative (WHI) made its headline-grabbing announcement. Even inside one of the country’s top academic hospitals, you could feel the shockwaves. Overnight, patients who had been thriving on hormone therapy (finally sleeping through the night, free of relentless hot flashes, protecting their bones) were suddenly terrified.

I remember the calls. Women wanted to know if they should stop their medication immediately. Many already had. Senior physicians who had prescribed hormones for decades began tapering patients off, uncertain what to believe after seeing the frightening headlines on the front pages of every newspaper and splashed across the evening news.

From my vantage point as a young oncologist-in-training, I watched in real time as fear replaced nuance. A treatment that had given countless women relief and protection was branded as toxic virtually overnight. Two decades later, we know the truth: the WHI’s message was oversimplified, distorted, and in crucial ways wrong, and women have been paying the price ever since.

In July 2002, the Women’s Health Initiative (WHI) called a press conference and announced that hormone replacement therapy increased the risk of breast cancer, heart attacks, and strokes. https://pubmed.ncbi.nlm.nih.gov/12117397/

Overnight, millions of women were told their medicine was dangerous. Prescriptions collapsed. Doctors stopped writing them. Patients stopped filling them.

The panic spread across the globe. In Europe, Canada, Australia, and Asia, women abandoned their hormones. A treatment that had been prescribed for decades to ease hot flashes, restore sleep, protect bones, and possibly guard the heart was branded as toxic.

That message was wrong.

What the WHI Was

The Women’s Health Initiative, launched in 1991, was one of the largest and most ambitious studies ever undertaken in women’s health. More than 160,000 postmenopausal women were enrolled to study the leading causes of death and disability in women: heart disease, breast and colorectal cancer, and osteoporotic fractures.

The hormone therapy arms were the centerpiece. Two regimens were tested:
-- Estrogen plus progestin (conjugated equine estrogen, or CEE, with medroxyprogesterone acetate, or MPA) in women with a uterus.
-- Estrogen alone (CEE) in women who had undergone hysterectomy.

The women who joined these trials were not the average 50-year-old struggling with hot flashes and insomnia. Their average age was 63. Most were more than a decade past menopause, and many already had risk factors such as obesity, hypertension, or diabetes. In other words, they did not resemble the women most likely to start hormone therapy in the real world.

In July 2002, the estrogen-progestin arm was abruptly halted after interim analyses suggested higher rates of breast cancer and cardiovascular events. At the press conference that followed, the results were reported in stark, frightening terms, with relative risks emphasized over absolute numbers. A “26 percent increase in breast cancer” sounded catastrophic; in reality, it meant eight additional cases per 10,000 women per year. That nuance was lost.

What the WHI Actually Found

The truth is that the WHI results were far more complex than the initial headlines suggested. Four years later, the same study group quietly published the results for women who took estrogen alone. The findings were the exact opposite of the alarmist headlines:
-- Estrogen alone lowered breast cancer risk by 23 percent and breast cancer deaths by 40 percent. Sixteen women on estrogen died of breast cancer, compared with 30 on placebo.
-- The combination therapy did not increase breast cancer deaths. The modest rise in diagnoses (about one extra case per thousand women per year) was driven largely by an unusually low rate of cancer in the placebo group.
-- Across both arms, no increase in breast cancer mortality was ever shown.
https://pubmed.ncbi.nlm.nih.gov/16609086/

Yet the original 2002 WHI’s alarmist message, that hormones cause breast cancer, became medical dogma almost overnight.

The Wrong Hormones, the Wrong Lesson

It is also crucial to understand what the WHI actually studied. The estrogen used, CEE (Premarin), is derived from horse urine, a cocktail of more than a dozen estrogenic compounds, none of which are identical to the estradiol women naturally produce. The progestin medroxyprogesterone acetate (Provera) is a synthetic drug with significantly different biological effects from natural progesterone.

MPA binds not only to progesterone receptors but also to androgen and glucocorticoid receptors, promoting inflammation, clotting, and adverse changes in breast tissue. Today, we rarely use it. Modern therapy looks very different: we prescribe bioidentical estradiol (molecularly identical to ovarian estrogen), usually delivered through a patch or gel that bypasses the liver and avoids clotting risks. To protect the uterus, we pair it with micronized progesterone (natural progesterone in an easily absorbed form) or with bazedoxifene, a selective estrogen receptor modulator. Bazedoxifene acts like estrogen in the bones but blocks its effects in the uterus and breast, preventing overgrowth or stimulation in these tissues.

In short, the WHI tested outdated formulations, then allowed their flawed conclusions to be generalized to all forms of hormone therapy, including the safer, physiologic regimens we use today.

The Mortality Toll

The consequences have been staggering. A Yale analysis estimated that 40,000 to 50,000 American women who had hysterectomies died prematurely in the decade after WHI because they avoided estrogen therapy. Apply that worldwide, and the toll rises into the hundreds of thousands. https://pubmed.ncbi.nlm.nih.gov/23865654/

And here is the cruel irony: by demonizing estrogen, the WHI almost certainly allowed millions more cases of breast cancer and more than a million breast cancer deaths that estrogen therapy could have prevented.

Why Estrogen Matters

Estrogen is not a luxury. It is a master regulator, with receptors in nearly every organ. Remove it, and the body unravels. Replace it, and balance is restored.
-- Hot flashes and sleep: Estrogen stabilizes the hypothalamic thermostat that drives flushing and sweats. Symptoms improve within days.
-- Mood and cognition: It enhances serotonin, dopamine, and acetylcholine, sharpening focus and easing depression.
-- Sexual health: It maintains blood flow, collagen, and elasticity in vaginal tissue, restoring intimacy.
-- Bone strength: It reins in bone-resorbing cells and protects bone-building ones, reducing fractures that often cripple or kill.
-- The heart and vessels: Estrogen boosts nitric oxide, keeps arteries supple, lowers LDL, raises HDL, and improves insulin sensitivity. When started near menopause, it lowers heart attacks and overall death rates.
-- Breast tissue: Far from fueling cancer, estrogen alone in WHI appeared to normalize breast cells and even trigger cell death in abnormal ones.
-- Metabolism: It improves insulin action and prevents the central fat gain that drives diabetes.
-- Longevity: By protecting heart, bone, metabolism, and breast, estrogen lowers all-cause mortality when begun at the right time.

This is not simply symptom relief. This is disease prevention.

A Global Tragedy

Today, only about 10 percent of women with menopausal symptoms receive hormone therapy, even though 80 percent suffer significantly. That means millions endure insomnia, brain fog, depression, painful s*x, and bone pain unnecessarily. Worse, they carry higher risks of heart disease, fractures, diabetes, and breast cancer, precisely the conditions hormones help prevent.

The WHI did not just change medical practice. It reshaped culture. For twenty years, the idea that “hormones cause cancer” has been repeated in exam rooms, dinner tables, and media sound bites. It has left a generation of women untreated, unprotected, and in many cases, dead too soon.

The Imperative for Change

Two decades on, even the WHI’s own investigators now acknowledge what should have been clear from the start: estrogen therapy is the most effective treatment for menopausal symptoms, and estrogen alone reduces breast cancer incidence and mortality. Yet the shadow of 2002 still lingers. Doctors remain fearful. Women remain skeptical.

Menopause experts worldwide now emphasize that hormone therapy is most effective and safest when started before age 60 or within 10 years of menopause onset. The timing matters, but for the majority of women who begin treatment in this window, the benefits clearly outweigh the risks. Modern formulations, especially bioidentical estradiol with micronized progesterone or bazedoxifene, have dramatically improved the safety profile compared to what WHI tested.

Breast oncologists also now acknowledge that estrogen-alone therapy reduces breast cancer incidence and deaths, but they remain cautious about systemic hormone therapy in women with a personal history of breast cancer, especially those with ER-positive disease. In these women, guidelines still recommend against systemic estrogen, though vaginal estrogen for severe symptoms may be considered on a case-by-case basis. These caveats do not diminish the fact that for the vast majority of women without a prior breast cancer diagnosis, hormone therapy is both safe and profoundly beneficial.

It is time to correct the record with the same force as the misinformation that spread from that press conference. Loudly. Publicly. Unequivocally.

Here is the truth:
-- Hormone therapy, when started at the right time, is safe.
-- Estrogen alone prevents breast cancer and saves lives.
-- Modern regimens (bioidentical estradiol combined with micronized progesterone or bazedoxifene) are safer, more natural, and more effective than the outdated drugs studied in the WHI.

Women deserve to know this. Doctors deserve to practice without fear. And society must reckon with the fact that one of the most influential medical studies in history triggered one of the greatest public health tragedies of our time.

In 2002, the WHI’s warning set off a global panic. Twenty years later, we know that panic was misguided, and deadly. The time has come to undo the damage. Women’s lives depend on it.

https://youtu.be/IMr1qviwACs

This video discusses Dr. Brian Lawenda's critique of the Women’s Health Initiative (WHI) study from 2002, argues that its initial, widely publicized findings...

09/28/2025

For as long as I’ve been practicing oncology, one message has been drilled into both patients and physicians: women who survive breast cancer should avoid hormone replacement therapy. The reasoning seemed airtight. Estrogen and progestin can fuel breast cancer growth, so supplementing them after treatment must surely increase the risk of recurrence.

Older trials appeared to confirm this fear.

In 1997, Swedish researchers launched the HABITS study — Hormonal Replacement After Breast Cancer: Is It Safe? By 2003, the trial was stopped early because women on hormone therapy were experiencing far more recurrences. After five years, nearly 22 percent of survivors in the HRT arm had developed a new breast cancer event, compared with just 8 percent in the control group. That absolute 14-point difference was dramatic, and it left a lasting mark. https://pubmed.ncbi.nlm.nih.gov/14962527

The LIBERATE trial, which opened in 2002, tested tibolone, a synthetic steroid with estrogenic, progestogenic, and androgenic properties. By the time results were published in 2009, the picture was once again concerning: 15.2 percent of women on tibolone had recurrences within just over three years, compared with 10.7 percent of those on placebo — an absolute difference of 4.5 points. https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045

Together, HABITS and LIBERATE solidified the prohibition. For the next two decades, hormone therapy was essentially taboo for breast cancer survivors. Women who endured hot flashes, insomnia, vaginal dryness, or bone pain were told to “tough it out” or to try non-hormonal alternatives. Many did, often at significant cost to their quality of life.

But another Swedish trial told a slightly different story.

The Stockholm Trial

Also launched in 1997, the Stockholm randomized trial was designed to minimize progestogen exposure, reflecting early concerns that progestins might be the key driver of risk. Like HABITS, it was shut down in 2003, but long-term follow-up was eventually published in 2013. https://pubmed.ncbi.nlm.nih.gov/22892060/

After a median of 10.8 years, overall recurrence rates were not significantly different: 31.9 percent in the HRT group versus 25.3 percent in controls (hazard ratio 1.3, 95% CI 0.9–1.9). Local and distant recurrences were nearly identical. The one red flag was contralateral breast cancer: 7.4 percent of HRT users developed a new cancer in the opposite breast, compared with 2.1 percent of controls (HR 3.6, p=0.013). Mortality, however, did not differ.

Taken together, these trials painted a complex picture: hormone therapy could increase risk, especially with higher doses and progestins, but the impact was not uniform. And critically, none of the studies showed an increase in breast cancer mortality.

That prohibition has shaped care for decades. Women suffering through hot flashes, insomnia, vaginal dryness, and bone loss were told to “tough it out” or rely on non-hormonal alternatives. Many did, often at significant cost to their quality of life.

But new evidence challenges this dogma.

A New Signal in BRCA Carriers

Fast forward to the 2025 ASCO Annual Meeting, where researchers from Toronto presented new data in women with BRCA1/2 mutations who had been treated for breast cancer. Some had used menopausal hormone therapy after diagnosis, others had not. https://ascopubs.org/doi/pdf/10.1200/JCO.2025.43.16_suppl.10506

Among more than 700 matched participants, the results were striking:
📍10-year overall survival was 93 percent among HRT users vs 80 percent in non-users.
📍Deaths occurred in 4.9 percent of HRT users vs 12.0 percent in non-users over a median of six years.
🔥The corresponding number of breast cancer deaths was 6 (3.3%) in HRT users vs 16 (8.7%) in non-users (p=0.03).

These preliminary findings suggest that hormone therapy, at least in this high-risk genetic subgroup, did not worsen outcomes — and may even have been compatible with improved survival.

Why Old Assumptions May Not Hold

It’s important to remember that the older trials tested regimens that look very different from what we prescribe today. HABITS and LIBERATE involved higher-dose, oral, combined estrogen-progestin pills or tibolone. In 2025, we more often use lower doses, transdermal estrogen, or estrogen-only regimens in carefully selected women.

Meanwhile, breast cancer care itself has advanced dramatically. Survivors today benefit from targeted therapies, CDK4/6 inhibitors, and more effective endocrine drugs, all of which lower recurrence risk in ways unimaginable when HABITS and Stockholm were conducted.

The risks we assumed in the 1990s may not reflect the risks faced by women in 2025.

Beyond Hormones: Expanding the Toolkit

To be clear, no one is suggesting that systemic hormones are universally safe. For many survivors, non-hormonal strategies remain first-line and effective.
--Antidepressants such as venlafaxine and citalopram can cut hot flashes nearly in half.
--Gabapentin, commonly used for seizures, works well for night sweats and insomnia.
--Clonidine has modest benefits, though side effects limit its use.
--Newer agents like fezolinetant, a neurokinin-3 receptor antagonist approved in 2023, target hot flashes directly through the brain’s thermostat.
--Even oxybutynin, a bladder medication, has shown strong activity in clinical trials.

Local therapies also matter. Vaginal estrogen creams, tablets, or rings (with minimal systemic absorption) are increasingly recognized as safe and effective for survivors struggling with s*xual health or urinary symptoms.

Taken together, these options offer women a far broader range of choices than they had a generation ago.

A Call for Individualized Care

The new BRCA data don’t prove that hormone therapy is safe for every survivor. But they do tell us that a blanket ban no longer makes sense. For a woman in her 30s who loses her ovaries, struggles with bone pain, insomnia, and cardiovascular risk, quality of life matters deeply. For her, the absolute risk of hormone therapy may be far smaller than we once believed.

What survivors deserve is not reflexive prohibitions based on trials nearly three decades old, but honest, individualized discussions about risks, benefits, and alternatives.

As oncologists, we owe it to our patients to revisit long-held assumptions. Hormone therapy may not be right for everyone — but for some women, it may no longer be the unthinkable option.

https://youtu.be/mD1wybKSODE

This video discusses the history and current perspectives on hormone replacement therapy (HRT) for breast cancer survivors. It addresses the long-standing pr...