Women with BRCA mutations can take hormone replacement therapy safely after ovary removal

It is my opinion that women with breast cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. should avoid using HRTAbbreviation for hormone replacement therapy, the administration of female hormones in cases where they are not sufficiently produced by the body. (except vaginal oestrogenA hormone involved in female sexual development, produced by the ovaries. creams) for at least two years after diagnosisThe process of determining which condition a patient may have.. The development of new drugs to reduce the risk of bone loss or osteoporosisA condition resulting in brittle bones due to loss of bony tissue. (such as bisphosphonatesA family of drugs that prevent the break down of bone by cells called osteoclasts. and raloxifene) and treat hot flushes (such as venlafaxine and gabapentin) should minimise the need for these women to use HRT.

Mastalgia literally means 'pain in the region of the breast' and is the most common symptom reported by women attending breast clinics. To make a full assessment of the cause, all patients require a full history, examination and, sometimes, investigations.True breast pain can either be cyclical (getting worse before menstruationThe shedding of the lining of the uterus (period), as part of the female reproductive cycle.) or non-cyclical (unrelated to menstruation). It is important to point out that breast cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. does not usually cause mastalgiaBreast pain.

Approximately one in five patients with breast cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. will require a mastectomy rather than a lumpectomy. As mastectomy results in the distortion of the body image, it is natural for some patients to seek reconstructive surgery. However, some women are just relieved to have had the cancer removed and are not keen on having breast reconstruction. Although an external implant is available that can be put inside the brassiere, it may be inadequate for some women.

The choice of reconstruction depends upon the woman's build, shape and size of her breasts, previous scars, and her own preferences.

A cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. can be considered as the uncontrolled growth of the cells of the body. There is unlikely to be a single cause of breast cancer but there are two categories of risk factors. We can look at things that seem to be associated with an increased risk and see if we can change any of these to reduce the risk.

Gynaecological cancers are not common, particularly in the UK. If we add all the gynaecological cancers that occur each year together, they account for less than half of the cases of breast cancer. However, women may be concerned about the possibility of gynaecological cancers because, unlike breast cancer, the gynaecological organs are not easily visible. It is therefore important for women to be aware of the various screeningA way to identify people who may have a certain condition, among a group of people who may or may not seem to programmes for gynaecological cancers that exist and to also be aware of the symptoms so that the disease can be detected early where full cure is usually possible.

To be told you have breast cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. is always a huge shock. Before we consider some of the treatments available I want to make the important point of how much the treatment of breast cancer has improved over the years. In the 1970s only 50% of people with breast cancer survived for 5 years. In the best units that figure is now around 90%. Similarly the 10 year survival rate was only 40% in the 70s and it is now 80%, with a twenty year survival rate of nearly 70%. The fundamental fact is that most people will no longer die from their breast cancer; and the treatments continue to improve.

Endometrial cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. is cancer of the lining of the wombThe uterus. and it is the most common gynaecological cancer in the UK. It is most common in post-menopausalAfter the menopause - technically only once a woman has had no menstrual period for one year. women aged 50 to 60 years, although approximately 7% of cases are in younger women.

Endometrial cancer is much more common among women who live in the developing world, particularly Europe and North America compared with women who live in less developed countries. This is likely to be because endometrialRelating to the endometrium. cancer is linked to obesityExcess accumulation of fat in the body., with obese women three times as likely to get this disease as women who have a body weight in the healthy range. A healthy balanced diet and an active lifestyle can help to reduce the risk of this cancer.

A nightmare of the future is that postmenopausal women with hot flushes, depressionFeelings of sadness, hopelessness and a loss of interest in life, combined with a sense of reduced emotional well-being, sexual problems and low bone density, who need oestrogens perhaps with testosteroneThe main male sex hormone., will be given a SSRIAn abbreviation for selective seratonin re-uptake inhibitors, a relatively new class of drug used to treat depression and bisphosphonate combination.  PROFOX , a Frankenstein combination of PROzac and FOsamaX. As these two drugs are now available as cheap generics they are already being prescribed together. 

The menopauseThe time of a woman’s life when her ovaries stop releasing an egg (ovum) on a monthly cycle. is a term that merely refers to the cessation of periods, for most women this occurs around the age of 51. The first important time is the five or ten years around the time of the menopauseThe time when a woman's periods permanently cease. when the worst of the symptoms occur. This is known as the ‘transition’ years leading up to the cessation of periods. After the transition years there are then often problems of vaginal atrophyWithering or weakening of a body tissue due to disease or disuse., painful sexual intercourse (dyspareuniaPain experienced by a woman during sexual intercourse.) and of course loss of bone tissueA group of cells with a similar structure and a specialised function. (osteoporosisA condition resulting in brittle bones due to loss of bony tissue.).

The risk of developing breast cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. increases with age; an average European woman aged 25 years has a 1 in 15000 chance of developing breast cancer; for a 40-year old woman the risk is 1 in 200, for a 50-year-old woman the chance is 1 in 50, and at the age of 80 years the chance is 1 in 11.

The number of cases of breast cancer is five times higher in Western countries than in Far Eastern countries such as Japan and China. However, Japanese women who move to the USA increase their risk of developing breast cancer, which shows that the environment also plays an important role.