HRT Found Safe After Early-Stage Breast Cancer.

DENVER -- There's no compelling reason to withhold HRT from survivors of early-stage breast cancer, Sarah Lena reported at the annual meeting of the Society of Teachers of Family Medicine.

She based that conclusion on a meta-analysis of six prospective observational cohort studies plus a 50-patient, randomized, controlled trial.

The use of HRT in breast cancer survivors was associated with a nonsignificant trend toward a reduced risk of recurrence--and moreover with a highly significant 69% reduction in all-cause mortality.

Ms. Lena's coinvestigator, Dr. Linda N. Meurer, advised against making too much of the sharply reduced overall mortality that was seen with HRT in the metaanalysis, which included data on 1,467 breast cancer survivors, most of whom had lower-stage disease.

Given the inherent limitations of metaanalysis--especially when the data come mainly from observational studies--it's likely that unmeasured confounders accounted for much of the apparent overall survival benefit of HRT, said Dr. Meurer, a family physician at the Medical College of Wisconsin, Milwaukee.

For example, women who use HRT may engage in other healthy behaviors that reduce their risk for breast cancer recurrence. It's also reasonable to suspect that physicians may be more willing to consider prescribing HRT in patients who have early-stage, better-prognosis breast cancer, That, too, introduces a form of bias into observational studies, she added.

The most important message that this new metaanalysis carries for physicians, she continued, is that it debunks the widely held concern that prescribing estrogen in breast cancer survivors might in effect be adding fuel to the fire.