Estrogen replacement therapy after treatment for localized breast carcinoma. Patient responses and opinions.

Abstract

Women who reach menopause after receiving treatment for breast carcinoma have been advised to avoid estrogen replacement therapy (ERT), but the validity of this practice is being reappraised and the need for prospective studies is discussed. The likely response of potential participants to the tangible rather than theoretic option for ERT provides not only useful information for planning such studies but also important insights into the attitudes and expectations of breast cancer survivors. Women with a history of localized breast carcinoma, potentially eligible for participation in this prospective ERT study, were interviewed in person or by telephone and were asked to consider participation in a prospective, randomized study of ERT. In addition, information was obtained regarding their disease stage, estrogen receptor (ER) status, age at diagnosis, age at interview, and elapsed time since cancer treatment. The authors contacted 555 women; 137 did not meet criteria for study participation. Among the 418 women eligible for the program, one-third indicated a lack of interest and cited travel, financial, or age considerations. One-third of the women were apprehensive about ERT risk and declined. Forty women (13%) were either already receiving ERT or were seeking a prescribing physician. Finally, 17% of the women enrolled in our study. There were no differences among the groups with respect to disease stage, ER status, age at diagnosis and interview, or time elapsed since cancer treatment. Women with a history of breast carcinoma harbor considerable reluctance regarding ERT for the management of menopausal health concerns. However, a significant minority have already opted for ERT and up to 20% may become participants in clinical programs. Plans for large scale trials of ERT in this subset of women require careful attention to patient attitudes and concerns.