Safety of hormone replacement therapy following risk-reducing salpingo-oophorectomy: systematic review of literature and guidelines

Abstract

Background: Women at high risk to develop ovarian cancer opt for risk-reducing salpingo-oophorectomy (RRSO) to reduce the risk by 80–96%. RRSO leads to a direct onset of menopause in premenopausal women. Hormone replacement therapy (HRT) can be used to mitigate menopausal symptoms after RRSO. However, it is unclear whether HRT in these women is safe in terms of breast cancer (BC) risk.

Methods: We performed a literature search and investigated national guidelines on the use of HRT following RRSO in BRCA1 and BRCA2 mutation carriers. We analyzed differences and similarities between the guidelines and describe what these guidelines were based upon.

Results: Seven articles regarding HRT following RRSO in BRCA1 and BRCA2 mutation carriers were identified. None of the included studies yielded any evidence that short-term use of HRT following RRSO increases the risk of developing BC or negates the protective effect of RRSO in BRCA1/2 mutation carriers without a personal history of BC. Eleven national guidelines were found and described.

Conclusion: Short-term use of HRT after RRSO seems to be safe. The literature is more favorable toward estrogen alone. The ideal dosage and duration of use are unknown and remain to be investigated in future studies.

摘要

背景：卵巢癌高危女性选择输卵管卵巢切除术（RRSO）以降低风险, 风险可降低80-96%。RRSO导致围绝经前女性直接步入绝经期。激素替代治疗（HRT）可用于缓解RRSO后的绝经相关症状。然而, 乳腺癌（BC）高风险女性的安全性尚不清楚。

方法：我们进行了文献检索, 并研究了携带BRCA1和BRCA2基因突变的RRSO诸侯HRT治疗的国家指南。我们分析了指南之间的异同, 并描述这些指南变化的基础。

结果：共发表了7篇关于BRCA1和BRCA2基因突变的RRSO术后的HRT文章。所有纳入的研究均未发现任何证据表明, RRSO术后短期使用HRT会增加乳腺癌的风险, 或者在没有BC病史的BRCA1/2基因突变携带者中否认RRSO的保护作用。并发现了11项国家指南。

结论：RRSO术后短期应用HRT是安全的。文献更倾向于单用雌激素。理想剂量及使用时间尚不清楚, 在未来的研究中有待继续研究。

Keywords:

• Hormone replacement therapy
• ovarian cancer
• cancer screening
• BRCA; menopause
• risk-reducing salpingo-oophorectomy
• breast cancer
• guidelines

Acknowledgements

The authors would like to thank the following gynecologists for looking up and translating their national guidelines: Päivi Tommola (Finland), Nina Bohm-Starke (Sweden), Mette Meinert (Denmark), Rainer Kürzl (Germany), Elmar Joura (Austria), Pedro Vieira Baptista (Portugal), and Luc van Lonkhuijzen and Helene Soubliere (Canada), and the clinical librarian who performed the systematic search, Elda de Cuba.

Potential conflict of interest

The authors report no conflicts of interest.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.