04/22/2026
𝐇𝐨𝐫𝐦𝐨𝐧𝐞 𝐑𝐞𝐩𝐥𝐚𝐜𝐞𝐦𝐞𝐧𝐭 𝐓𝐡𝐞𝐫𝐚𝐩𝐲 𝐀𝐟𝐭𝐞𝐫 𝐁𝐫𝐞𝐚𝐬𝐭 𝐂𝐚𝐧𝐜𝐞𝐫: There are real risks to denying this care to breast cancer survivors.
Use of menopausal hormone therapy (HT) fell precipitously after 2002, largely as a result of the Women's Health Initiative's report claiming that the combination of conjugated equine estrogen (CEE) and medroxyprogesterone acetate increased breast cancer risk and did not improve quality of life (two drugs we shouldn't really be reaching for first).
A generation of women has been deprived of HT largely as a result of this 𝐰𝐢𝐝𝐞𝐥𝐲 𝐩𝐮𝐛𝐥𝐢𝐜𝐢𝐳𝐞𝐝 𝐦𝐢𝐬𝐢𝐧𝐭𝐞𝐫𝐩𝐫𝐞𝐭𝐚𝐭𝐢𝐨𝐧 𝐨𝐟 𝐭𝐡𝐞 𝐝𝐚𝐭𝐚. This article attempts to rectify this misunderstanding, with the goal of helping patients and physicians make informed joint decisions about the use of HT. [1]
Twenty-five studies of HRT after a breast cancer diagnosis, published... Only 1 of the 25 studies, the HABITS trial, demonstrated an increased risk of recurrence, which was limited to local or contralateral, and not distant, recurrence. "𝐍𝐨𝐧𝐞 𝐨𝐟 𝐭𝐡𝐞 𝐬𝐭𝐮𝐝𝐢𝐞𝐬, 𝐢𝐧𝐜𝐥𝐮𝐝𝐢𝐧𝐠 𝐇𝐀𝐁𝐈𝐓𝐒, 𝐫𝐞𝐩𝐨𝐫𝐭𝐞𝐝 𝐢𝐧𝐜𝐫𝐞𝐚𝐬𝐞𝐝 𝐛𝐫𝐞𝐚𝐬𝐭 𝐜𝐚𝐧𝐜𝐞𝐫 𝐦𝐨𝐫𝐭𝐚𝐥𝐢𝐭𝐲 𝐚𝐬𝐬𝐨𝐜𝐢𝐚𝐭𝐞𝐝 𝐰𝐢𝐭𝐡 𝐇𝐑𝐓." [2] Zero!!
"Based on the available data, we recommend that shared decisions are based on (1) an individual's menopausal symptoms and impact on quality of life, (2) the potential increase in an individual's risk of relapse by use of menopausal hormone therapy, and (3) patient preferences, views and treatment goals. 𝐂𝐥𝐢𝐧𝐢𝐜𝐢𝐚𝐧𝐬 𝐚𝐧𝐝 𝐩𝐚𝐭𝐢𝐞𝐧𝐭𝐬 𝐜𝐚𝐧 𝐮𝐬𝐞 𝐨𝐮𝐫 𝐟𝐢𝐧𝐝𝐢𝐧𝐠𝐬 𝐭𝐨 𝐦𝐚𝐤𝐞 𝐢𝐧𝐟𝐨𝐫𝐦𝐞𝐝 𝐦𝐞𝐧𝐨𝐩𝐚𝐮𝐬𝐞 𝐭𝐫𝐞𝐚𝐭𝐦𝐞𝐧𝐭 𝐜𝐡𝐨𝐢𝐜𝐞𝐬 𝐚𝐟𝐭𝐞𝐫 𝐛𝐫𝐞𝐚𝐬𝐭 𝐜𝐚𝐧𝐜𝐞𝐫." [3]
"Conclusions and Relevance: 𝐑𝐞𝐬𝐮𝐥𝐭𝐬 𝐨𝐟 𝐭𝐡𝐢𝐬 𝐬𝐭𝐮𝐝𝐲 𝐬𝐡𝐨𝐰𝐞𝐝 𝐧𝐨 𝐞𝐯𝐢𝐝𝐞𝐧𝐜𝐞 𝐨𝐟 𝐢𝐧𝐜𝐫𝐞𝐚𝐬𝐞𝐝 𝐞𝐚𝐫𝐥𝐲 𝐛𝐫𝐞𝐚𝐬𝐭 𝐜𝐚𝐧𝐜𝐞𝐫-𝐬𝐩𝐞𝐜𝐢𝐟𝐢𝐜 𝐦𝐨𝐫𝐭𝐚𝐥𝐢𝐭𝐲 𝐢𝐧 𝐩𝐚𝐭𝐢𝐞𝐧𝐭𝐬 𝐰𝐡𝐨 𝐮𝐬𝐞𝐝 𝐯𝐚𝐠𝐢𝐧𝐚𝐥 𝐞𝐬𝐭𝐫𝐨𝐠𝐞𝐧 𝐭𝐡𝐞𝐫𝐚𝐩𝐲 𝐜𝐨𝐦𝐩𝐚𝐫𝐞𝐝 𝐰𝐢𝐭𝐡 𝐩𝐚𝐭𝐢𝐞𝐧𝐭𝐬 𝐰𝐡𝐨 𝐝𝐢𝐝 𝐧𝐨𝐭 𝐮𝐬𝐞 𝐇𝐑𝐓. This finding may provide some reassurance to prescribing clinicians and support the guidelines suggesting that vaginal estrogen therapy can be considered in patients with breast cancer and genitourinary symptoms." [4]
AND, cardiovascular/heart-specific death is higher in breast cancer patients than the general population and withholding estradiol exacerbates this.
"The risk of heart-specific death is significantly higher in breast cancer patients than in the general population and closely related to demographic characteristics and tumor clinicopathological factors. Medical approaches are needed to reduce the risk of heart disease among patients with breast cancer." [5]
Withholding care is not benign or without significant risk which is often not discussed, or weighed.
Cited:
1) Bluming AZ, Hodis HN, Langer RD. ‘Tis but a scratch: a critical review of the Women’s Health Initiative evidence associating menopausal hormone therapy with the risk of breast cancer. Menopause. 2023;30(12):1241-1245.
2) Bluming AZ. Hormone Replacement Therapy After Breast Cancer: It Is Time. Cancer J. 2022;28(3):183-190.
3) Glynne S, Simon J, Branson A, et al. Menopausal hormone therapy for breast cancer patients: what is the current evidence? Menopause. 2026;33(1):88-117.
4) McVicker L, Labeit AM, Coupland CAC, et al. Vaginal estrogen therapy use and survival in females with breast cancer. JAMA Oncol. 2024;10(1):103-108.
5) Luo Y, Zhao et al. The risk of heart-specific death in breast cancer patients. Sci Rep. 2025 Aug 2;15(1):28228. .
