Vikram Sinai Talaulikar: Current Best Evidence on MHT in Ovarian Cancer Survivors
Vikram Sinai Talaulikar, Associate Specialist in Reproductive Medicine at UCLH and Hon, shared a post on LinkedIn:
“In this very useful editorial, Piral et al. analyse the relationship between menopausal hormone therapy (MHT) and the incidence and prognosis of ovarian cancer (OC), and whether MHT may be prescribed in OC survivors.
The researchers present risk estimates for women with low, moderate and high risk of developing OC and also advise on use of MHT after OC. They go on to discuss the current best evidence for prescribing MHT in cancer survivors and acknowledge the limitations of evidence in certain areas.
MHT probably very slightly increases the risk of developing OC in the general population with the additional risk of OC attributable to using MHT in the range of 1 per 1000 woman-years to 1.5 per 10.000 woman-years. But we still need better evidence stratifying the risk based on type, frequency and dosage of hormones used. For majority of women benefits of MHT would outweigh such risks.
The authors note that women who suffer from endometriosis, and especially those with endometrioma and deep infiltrating endometriosis, may have an increased risk of developing OC, but this is not a contraindication for MHT.
Carriers of genetic causes for OC are offered prophylactic salpingo-oophorectomy and although conflicting data exist, current recommendations suggest treating them with MHT at least until the age of the natural menopause (50).
Prior use of MHT before diagnosis of OC does not worsen the prognosis and may improve it. The authors recommend that MHT may be used in survivors of ovarian germ cell or epithelial OCs, but may not be appropriate for those treated for low-grade serous and granulosa cell sex cord stromal tumors.
Clinical evidence will keep evolving in this area and further studies and trials will hopefully clarify some of the current uncertainties that persist. Until then, counselling women accurately based on the current data we have will be important.”
Title: Menopausal hormone therapy and ovarian cancer: Risk assessment of various regimens and risk evaluation in ovarian cancer survivors
Authors: J. Piral, S. Rozenberg, S. Blaiberg, J. Vandromme, P. Revercez
Read the full article.
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