Estrogen Replacement Therapy in Breast Cancer Survivors

POSTMENOPAUSAL women often experience annoying and sometimes debilitating menopausal symptoms, and breast cancer survivors are no exception. Hot flashes, dyspareunia, atrophic vaginitis with attendant urinary tract symptoms, sleep disturbance, and mood change are among these symptoms. Coronary artery disease and osteoporosis may be more insidious, but potentially fatal consequences of menopausal estrogen decline. Estrogen replacement therapy (ERT) has been shown to ameliorate these problems,1,2and as informed consumers, breast cancer survivors are increasingly inquiring about and/or requesting ERT.3 There are more breast cancer survivors alive now than ever before, so their nononcologic health problems are a growing concern. A dramatic rise in the incidence rates of breast cancer occurred in the United States between 1982 and 1987, presumably because of increased screening.4The incidence of noninvasive and of small, invasive, axillary nodenegative breast cancers rose concurrently.4Five-year survival rates for breast cancer patients also have been