Evolving Risk and Emerging Guidance of Hormone Replacement Therapy in Women with Breast Cancer

Authors

Sally M. Hur, University of LynchburgFollow

Abstract

Hormone replacement therapy (HRT) has long been avoided in women with a history of breast cancer due to concerns about recurrence, particularly in estrogen receptor–positive cases. However, growing evidence suggests that a universal prohibition is no longer justified. This clinical review examines evolving data on the risks and benefits of HRT in breast cancer survivors and highlights emerging guidance that supports more individualized, evidence-based decision-making.

Recent studies show that while systemic HRT remains generally contraindicated in most hormone-sensitive cancers, carefully selected patients, especially those with estrogen receptor–negative disease or severe menopausal symptoms, may benefit from limited, closely monitored use. Local estrogen therapies for genitourinary symptoms have demonstrated minimal systemic absorption and no meaningful increase in recurrence risk. Yet, many patients continue to receive outdated or overly cautious counseling, leaving symptoms untreated and quality of life diminished.

A comprehensive literature review of studies from 2000 to 2024 reveals a growing consensus that treatment decisions should consider cancer subtype, symptom burden, time since diagnosis, and patient preference. Current guidelines emphasize the importance of shared decision-making and multidisciplinary collaboration. By integrating these principles into survivorship care, clinicians can move beyond outdated assumptions and better address the complex needs of breast cancer survivors experiencing menopause.

Recommended Citation

Hur SM. Evolving Risk and Emerging Guidance of Hormone Replacement Therapy in Women with Breast Cancer. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2025; 7(3).