I am often asked whether breast cancer survivors can ever safely initiate HRT. In addition, they are often taking estrogen blocker drugs, like tamoxifen, especially if their breast cancer was positive for estrogen receptors. These women frequently suffer severe symptoms of estrogen deficiency.

According to the 2010 Position Statement of the North American Menopause Society, controversy still exists regarding the safety of initiating HRT in breast cancer survivors. Two concurrent, randomized controlled trials, (the most reliable type of clinical studies) reported conflicting results. One study reported no harm and the other showed a statistically significant 2.4 fold increase in new breast cancer events.

In some women in remission for five years, who are severely symptomatic, their oncologists or breast surgeons permit them to start using low dose HRT. However, I must emphasize this practice is done on a case-by-case basis between a woman and her oncologist when a woman’s quality of life is so poor she is willing to accept a possible increased risk of cancer recurrence. HRT should never be given to a breast cancer survivor without the express consent and ongoing surveillance by her oncologist or breast surgeon.

Marina Johnson, M.D., F.A.C.E.
Medical Director

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