Hormone therapy and breast cancer risk after ovary removal in women with a BRCA1 mutation
Full article: https://jamanetwork.com/journals/jamaoncology/article-abstract/2678466
Does hormone therapy (HT) alter the risk of breast cancer for woman carrying a BRCA1 mutation who have never been diagnosed with cancer? In this study, researchers showed that among women with
BRCA1 mutations, HT use did not increase breast cancer rates for 10 years after ovary removal. More women taking combined estrogen plus progesterone developed breast cancer compared to those taking estrogen only, though this difference was not statistically significant. (9/7/18)
The National Comprehensive Cancer Network (NCCN) creates guidelines for the management of risk in women at high risk for cancer.
Guidelines for oophorectomy in high risk women
- NCCN recommends risk-reducing salpingo-oophorectomy for women with BRCA1 and BRCA2 mutations.
- For women with BRCA1 mutations the surgery is recommended between age 35 and 40 and upon completion of child bearing.
- For women with BRCA2 mutations they state that delaying risk-reducing removal of ovaries and fallopian tubes until age 40-45 is “reasonable."
- NCCN suggests that women with Lynch Syndrome, BRIP1 or RAD51C or RAD51D consider undergoing the surgery.
Guidelines for hormone replacement after salpingo-oophorectomy in high risk women
In their guidelines NCCN also states that hormone replacement therapy in women who have RRSO does not negate the reduction in breast cancer risk associated with the surgery. However they do highlight the limitations of the existing research .
The North American Menopause Society is a professional society of experts in the field of menopause. In 2017 they released a position statement on hormone replacement therapy, which includes the following:
- Menopause symptoms and a variety of symptoms and diseases are more likely to occur in women who have surgical menopause from ovary removal. These symptoms can have a major effect on quality of life and potential adverse effects on the cardiovascular system, bone, mood, sexual health and cognition, which have been shown in observational studies to be lessened by estrogen therapy.
- Unless contraindications are present, estrogen therapy is indicated for women who have removed both ovaries, to reduce their risk of sexual side effects, bone loss, heart disease and cognitive decline. For women who retain their uterus, endometrial protection (eg-progesterone) is indicated.
Specific to women with BRCA1 or BRCA2 mutations who have removed their ovaries to lower their risk for cancer, they include the following:
- For women with BRCA1 or BRCA2 mutations who have not be diagnosed with breast there is some evidence suggesting that that hormone therapy use after oophorectomy does not increase the risk for breast cancer any further.
- Considerations should be made about the benefits of estrogen to prevent health risks caused by surgical menopause.
- Considerations should be made (based on a limited amount of data) about hormone therapy until age 52 with discussions about longer use based on the individual patient.
Questions To Ask Your Health Care Provider
- Should I consider using HT after risk-reducing ovary removal? After menopause?
- What kind of HT would be most appropriate for me?
- What are other options for managing menopause without HT?
- What risks are associated with taking or not taking HT after removal of my ovaries?
- Can you refer me to a menopause expert?
FORCE is a national nonprofit organization, established in 1999. Our mission is to improve the lives of individuals and families affected by adult hereditary cancers.