HORMONAS FEMENINAS Y CÁNCER DE MAMA: ESTADO DE LA POLÉMICA Y EVIDENCIAS EN 2008. ¿QUE RESPONDER A LAS PACIENTES?

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

El uso de terapia de reemplazo hormonal ha evolucionado desde su empleo masivo a un uso restringido bajo indicaciones precisas, a la luz de los efectos deletéreos que pudiera significar su indicación indiscriminada. No es de utilidad en la prevención secundaria y más bien representa riesgos adicionales cardiovasculares y cerebro vasculares, por lo que se debe emplear de preferencia en el periodo peri-menopáusico y no tardío, en la menor dosis posible y por el menor tiempo necesario, restringiendo su indicación a las mujeres con síntomas de deprivación estrogénica severa o a mujeres osteoporóticas que no toleran la terapia de calcio y bifosfonatos. El riesgo de cáncer de mama -que es bajo- está relacionado con una terapia estrogénica prolongada de 7 años o más o en asociación con el empleo de progesterona por más de 5 años. Antecedentes personales de cáncer de mama representan una contraindicación absoluta. No hay trabajos a la fecha que apoyen el empleo sin riesgo de fitoestrógenos como una terapia alternativa al uso de estrógenos. Es posible que en el futuro la administración transdérmica de los estrógenos, asociado a progesteronas naturales permitan su mayor utilización, pero aún no se dispone de estudios masivos que aprueben su recomendación.

Translated abstract

The use ofHormone Replacement Therapy (HRT) has evolved from a massive utilization to a restricted use under very precise medical indications, in the light of the deletereous effects its indiscriminate prescription could entail. It is not beneficial for secondary prevention, but rather implies additional cardiocerebrovascular risks, and therefore it must be preferentially employed during perimenopausic and non-late periods, in the smallest possible dose and only over short periods of time, restricting its prescription to women presenting with severe estrogen deprivation syndrome or to osteoporotic patients intolerant to calcium and bifosfonates therapy. Breast cáncer risk -which is low- is related to a estrogen theraphy extended for more than seven years or associated with the use of progesterone for a period exceeding five years. Personal medical records of breast cáncer imply absolute contraindication. Currently there are no research work supporting the safe use of phytoestrogens as an altenative therapy. It is likely that in upcoming days transdermal estrogen administration associated with natural progesterone could allow an increased use of them, but for the time being there are no massive studies supporting their recommendation.

Related collections

Most cited references 87

Record: found
Abstract: found
Article: not found

Endogenous sex hormones and breast cancer in postmenopausal women: reanalysis of nine prospective studies.

T Key, P Appleby, I. Barnes … (2002)

Reproductive and hormonal factors are involved in the etiology of breast cancer, but there are only a few prospective studies on endogenous sex hormone levels and breast cancer risk. We reanalyzed the worldwide data from prospective studies to examine the relationship between the levels of endogenous sex hormones and breast cancer risk in postmenopausal women. We analyzed the individual data from nine prospective studies on 663 women who developed breast cancer and 1765 women who did not. None of the women was taking exogenous sex hormones when their blood was collected to determine hormone levels. The relative risks (RRs) for breast cancer associated with increasing hormone concentrations were estimated by conditional logistic regression on case-control sets matched within each study. Linear trends and heterogeneity of RRs were assessed by two-sided tests or chi-square tests, as appropriate. The risk for breast cancer increased statistically significantly with increasing concentrations of all sex hormones examined: total estradiol, free estradiol, non-sex hormone-binding globulin (SHBG)-bound estradiol (which comprises free and albumin-bound estradiol), estrone, estrone sulfate, androstenedione, dehydroepiandrosterone, dehydroepiandrosterone sulfate, and testosterone. The RRs for women with increasing quintiles of estradiol concentrations, relative to the lowest quintile, were 1.42 (95% confidence interval [CI] = 1.04 to 1.95), 1.21 (95% CI = 0.89 to 1.66), 1.80 (95% CI = 1.33 to 2.43), and 2.00 (95% CI = 1.47 to 2.71; P(trend)<.001); the RRs for women with increasing quintiles of free estradiol were 1.38 (95% CI = 0.94 to 2.03), 1.84 (95% CI = 1.24 to 2.74), 2.24 (95% CI = 1.53 to 3.27), and 2.58 (95% CI = 1.76 to 3.78; P(trend)<.001). The magnitudes of risk associated with the other estrogens and with the androgens were similar. SHBG was associated with a decrease in breast cancer risk (P(trend) =.041). The increases in risk associated with increased levels of all sex hormones remained after subjects who were diagnosed with breast cancer within 2 years of blood collection were excluded from the analysis. Levels of endogenous sex hormones are strongly associated with breast cancer risk in postmenopausal women.

0 comments Cited 287 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial.

Judith Ockene, Karen H. Black, Robert Brzyski … (2004)

Despite decades of use and considerable research, the role of estrogen alone in preventing chronic diseases in postmenopausal women remains uncertain. To assess the effects on major disease incidence rates of the most commonly used postmenopausal hormone therapy in the United States. A randomized, double-blind, placebo-controlled disease prevention trial (the estrogen-alone component of the Women's Health Initiative [WHI]) conducted in 40 US clinical centers beginning in 1993. Enrolled were 10 739 postmenopausal women, aged 50-79 years, with prior hysterectomy, including 23% of minority race/ethnicity. Women were randomly assigned to receive either 0.625 mg/d of conjugated equine estrogen (CEE) or placebo. The primary outcome was coronary heart disease (CHD) incidence (nonfatal myocardial infarction or CHD death). Invasive breast cancer incidence was the primary safety outcome. A global index of risks and benefits, including these primary outcomes plus stroke, pulmonary embolism (PE), colorectal cancer, hip fracture, and deaths from other causes, was used for summarizing overall effects. In February 2004, after reviewing data through November 30, 2003, the National Institutes of Health (NIH) decided to end the intervention phase of the trial early. Estimated hazard ratios (HRs) (95% confidence intervals [CIs]) for CEE vs placebo for the major clinical outcomes available through February 29, 2004 (average follow-up 6.8 years), were: CHD, 0.91 (0.75-1.12) with 376 cases; breast cancer, 0.77 (0.59-1.01) with 218 cases; stroke, 1.39 (1.10-1.77) with 276 cases; PE, 1.34 (0.87-2.06) with 85 cases; colorectal cancer, 1.08 (0.75-1.55) with 119 cases; and hip fracture, 0.61 (0.41-0.91) with 102 cases. Corresponding results for composite outcomes were: total cardiovascular disease, 1.12 (1.01-1.24); total cancer, 0.93 (0.81-1.07); total fractures, 0.70 (0.63-0.79); total mortality, 1.04 (0.88-1.22), and the global index, 1.01 (0.91-1.12). For the outcomes significantly affected by CEE, there was an absolute excess risk of 12 additional strokes per 10 000 person-years and an absolute risk reduction of 6 fewer hip fractures per 10 000 person-years. The estimated excess risk for all monitored events in the global index was a nonsignificant 2 events per 10 000 person-years. The use of CEE increases the risk of stroke, decreases the risk of hip fracture, and does not affect CHD incidence in postmenopausal women with prior hysterectomy over an average of 6.8 years. A possible reduction in breast cancer risk requires further investigation. The burden of incident disease events was equivalent in the CEE and placebo groups, indicating no overall benefit. Thus, CEE should not be recommended for chronic disease prevention in postmenopausal women.