Breast cancer is the most frequently diagnosed
cancer in Canadian women. As a result of increased screening and improved treatment, more women are becoming long-term
breast cancer survivors. However, due to either their treatment or prolonged survival, many of these women now have to face the consequences of
premature menopause and prolonged
estrogen deprivation.
Hormone replacement therapy/
estrogen replacement therapy (HRT/ERT) has, in the past, been recommended to healthy women at menopause not only for relief of short-term menopausal changes, particularly
hot flashes, but also for its benefits on bone density,
fracture reduction, and genitourinary symptoms. Recent studies have demonstrated that not only is HRT associated with an increased risk of developing
breast cancer, but it also has been shown to increase the risk of recurrence in those with a
breast cancer history. Until the safety of HRT/ERT in
breast cancer patients can be more fully clarified, it would be wise to develop alternative strategies for the management of menopausal symptoms in these patients. This paper will discuss nonestrogen-based
therapies for
hot flashes,
osteoporosis, and genitourinary symptoms, with emphasis on efficacy and safety in
breast cancer survivors.