Experiences from a prospective study of estrogen replacement therapy after treatment of breast cancer

Abstract

Estrogen deficiency can develop in women undergoing treatment for breast cancer. However, these women are generally advised against estrogen replacement therapy (ERT). Prior to starting a prospective, randomized study to investigate the effect of ERT after treatment of localized breast cancer, patients' and physicians' attitudes towards ERT were assessed. Overall half of the women contacted said that they would consider taking estrogen under medical supervision. Those who had surgery were more likely to consider ERT (71%) than those who received other multimodality treatments. Premenopausal women were more concerned about osteoporosis than menopausal women (82% vs. 66%) and more concerned about cardiovascular disease (92% vs. 73%), and they were more willing to consider taking ERT (59% vs. 40%). Physicians' responses reinforced the view that prospective, randomized studies are necessary to define the safety of ERT in selected groups of women with breast cancer. A prospective study was then initiated to define the safety of ERT. An analysis of women's attitudes was carried out after the first 555 potential candidates were identified: 137 were not fully eligible, 346 declined to participate and 72 (13%) agreed to the randomized trial. Reasons for declining to participate were varied. Trial recruitment is continuing, but at a slower rate than originally anticipated. Significant reluctance towards ERT persists among patients with breast cancer and this reluctance makes recruitment difficult. However, increased awareness and discussion are providing the impetus towards developing more studies designed to address this important issue.

Key Words:

• BREAST CANCER
• ESTROGEN REPLACEMENT
• MENOPAUSE
• PATIENT ATTITUDES