Hormones and breast cancer
Wile, A.G.; DiSaia, P.J.
American Journal of Surgery 157(4): 438-442
1989
ISSN/ISBN: 0002-9610 PMID: 2648885 DOI: 10.1016/0002-9610(89)90596-5Document Number: 369298
This review raises the issue whether endogenous or exogenous estrogens, such as those circulating during pregnancy, oral contraception or hormonal replacement therapy, have an adverse effect on the course of breast cancer. Breast cancer has traditionally been managed by terminating pregnancy and contraindicating estrogen therapy. Breast cancer is difficult to detect in pregnancy, even by mammography. It is now recognized that pregnant women without axillary lymph node cancer have a favorable prognosis, that most breast cancers arising during pregnancy are not estrogen-receptor positive, and that youth, not pregnancy, is the independent risk factor for poor prognosis. Women whose cancer was successfully managed often do better if they subsequently become pregnant than do those who do not. Furthermore, additive hormonal therapy, and therapy using tamoxifen, a estrogen- antagonist, are effective. The U.S. Food and Drug Administration stated in 1984 that there is no increased risk of breast cancer in users of oral contraceptives. Possibly the improved surveillance and earlier diagnosis of pill users, who see doctors regularly, contribute toward better prognosis of those who do develop cancer. So far there is no evidence that women on hormonal replacement therapy are at increased risk for breast cancer.