Volume 176 - Issue 12
Safety of hormone replacement therapy after mastectomy
Authors: Robert N Hitchins and Christopher M Pyke
Med J Aust 2002; 176 (12): 617-620. || doi: 10.5694/j.1326-5377.2002.tb04601.x
Published online: 17 June 2002
Published online: 17 June 2002
To the Editor: I was pleased to see the issue of hormone replacement therapy (HRT) after breast cancer raised by Del Mar and colleagues in a recent issue of the Journal.1 However, I was a little disappointed to see that Australian research in this area had been "missed" by their search.2,3 There are a number of other studies that I am aware of which would suggest to me that perhaps their search technique was not particularly thorough.4-7
Nonetheless, I should add that I do agree with their conclusions. In fact, I am not aware of any clinical trials that have shown an adverse effect of HRT after a diagnosis of breast cancer. However, the studies examined by Del Mar and colleagues are all population studies and not randomised controlled trials.
I also think it's important that the readers of the Journal understand that there are other strategies for controlling menopause symptoms after breast cancer, such as the use of progestins, antidepressants and stress-reduction techniques. Even though the evidence we have suggests that HRT after breast cancer is "safe", we do not have even one published randomised trial on this question, so caution should be the rule. HRT after breast cancer should always be viewed as a last resort.
References
- Allen IE, Olkin I. Estimating time to conduct a meta-anlaysis from number of citations retrieved. JAMA 1999; 282: 634-635. c1
- Del Mar CB, Silagy CA, Glasziou PP, et al. Feasibility of an evidence-based literature search service for general practitioners. Med J Aust 2001; 175: 134-137. c2
- Girgis S, Ward JE, Thomson CJH. General practitioners' perceptions of medicolegal risk. Med J Aust 1999; 171: 362-366. c3
- Levinson W. Physician-patient communication. A key to malpractice prevention [editorial]. JAMA 1994; 272: 1619-1620. c4
- Brewer EC. Dictionary of phrase and fable. Philadelphia: Henry Altemus, 1898; Bartleby, 2000. c5