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Hormone replacement therapy in BRCA mutation carriers: how shall we do no harm?

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Abstract

Women with a BRCA mutation have an increased risk of developing breast and ovarian cancer. Bilateral salpingo-oophorectomy is the only effective strategy to reduce this risk. Risk-reducing bilateral salpingo-oophorectomy (RRSO) is recommended between the ages of 35 and 40 for women carriers of BRCA1 and between the ages of 40 and 45 for women carriers of BRCA1 and BRCA2 mutations. Most women undergo this procedure prior to their natural menopause subsequently developing an anticipated lack of hormones. This condition affects the quality of life and longevity, while it is more pronounced in women carrying a BRCA1 mutation compared to BRCA2 because they are likely to have surgery earlier. Hormone replacement therapy (HRT) is the only strategy able to significantly compensate for the loss of ovarian hormone production and counteract menopausal symptoms. There is strong evidence that short-term HRT use does not increase the risk of breast cancer among women with a BRCA1 mutation. Few data are available on BRCA2 mutation carriers. Therefore, BRCA mutation carriers require careful counseling about the outcomes of their RRSO, including menopausal symptoms and/or the fear associated with HRT use.

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Data Availability

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

Abbreviations

RRBSO:

Risk-reducing bilateral salpingo-oophorectomy

HRT:

Hormone replacement therapy

HR:

Hazard ratio

CI:

Confidence interval

BC:

Breast cancer

RRSO:

Risk-reducing salpingo-oophorectomy

NCCN:

National Comprehensive Cancer Network

WHI:

Women’s Health Initiative

ESHRE:

European Society of Human Reproduction and Embryology

MWS:

Million Women Study

EC:

Endometrial cancer

OC:

Ovarian cancer

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Authors and Affiliations

  1. Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, 70124, Bari, Italy

    Vera Loizzi & Gennaro Cormio

  2. Oncology Unit IRCSS Istituto Tumori “Giovanni Paolo II”, 70124, Bari, Italy

    Vera Loizzi & Gennaro Cormio

  3. Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy

    Miriam Dellino, Marco Cerbone, Francesca Arezzo, Giulia Chiariello, Gianluca Raffaello Damiani & Ettore Cicinelli

  4. Clinic of Obstetrics and Gynecology, San Paolo” Hospital, ASL Bari, Bari, Italy

    Miriam Dellino

  5. Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, Bari, Italy

    Gerardo Cazzato

  6. Department of Medical Sciences, University of Turin, 10124, Turin, Italy

    Eliano Cascardi

  7. Pathology Unit, FPO-IRCCS Candiolo Cancer Institute, 10060, Candiolo, Italy

    Eliano Cascardi

  8. Section of Gynecology and Obstetrics, Department of Interdisciplinar Medicine(DIM), University of Bari “Aldo Moro”, 70124, Bari, Italy

    Achiropita Lepera

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  1. Vera Loizzi
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  2. Miriam Dellino
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  3. Marco Cerbone
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  4. Francesca Arezzo
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  5. Giulia Chiariello
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Correspondence to Miriam Dellino.

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The manuscript had ethical approval. The Ethical Review Board was obtained from the Ethics Committee of the Policlinico Bari, Italy, who approved the study protocol.

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Loizzi, V., Dellino, M., Cerbone, M. et al. Hormone replacement therapy in BRCA mutation carriers: how shall we do no harm?. Hormones 22, 19–23 (2023). https://doi.org/10.1007/s42000-022-00427-1

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