Department of Gynecology and Obstetrics, University Medical Center Regensburg, Regensburg, Germany.
Center for Hereditary Breast and Ovarian Cancer, University Hospital of Cologne, Cologne, Germany.
J Cancer Res Clin Oncol. 2021 Jul;147(7):2035-2045. doi: 10.1007/s00432-021-03629-z. Epub 2021 Apr 22.
PURPOSE: BRCA mutation carriers have an increased risk of developing breast or ovarian cancer. Risk-reducing bilateral salpingo-oophorectomy (RRBSO) is associated with a decrease in risk for tubal and ovarian cancer. Hormone replacement therapy (HRT) may increase breast, ovarian, and endometrial cancer risk in the general population. This review analyses the published data on HRT and risk of cancer in BRCA mutation carriers with and without RRBSO. METHODS: We included all relevant articles published in English from 1995 to October 2020. Sources were identified through a search on PubMed and Cochrane Library. RESULTS: We included one case-control and one retrospective cohort study on ovarian and one case-control study on endometrial cancer risk and HRT in BRCA mutation carriers. Regarding breast cancer risk, one case-control study on BRCA mutation carriers with and without RRBSO and one case-control study, one Markov chain decision model, two prospective cohort studies, and one metaanalysis on carriers after RRBSO were included. For ovarian cancer, results were ambiguous. For breast cancer, most studies did not find an adverse effect associated with HRT. However, some of the studies found a risk modification associated with different formulations and duration of use. CONCLUSION: Although data are limited, HRT does not seem to have a relevant effect on cancer risk in BRCA mutation carriers. RRBSO should not be postponed to avoid subsequent HRT in this population. Adequate HRT after RRBSO should be offered to avoid chronic diseases resulting from low estrogen levels. However, further data on the safety of different formulations are needed.
目的:BRCA 基因突变携带者发生乳腺癌或卵巢癌的风险增加。降低风险的双侧输卵管卵巢切除术(RRBSO)与降低输卵管和卵巢癌风险相关。激素替代疗法(HRT)可能会增加普通人群乳腺癌、卵巢癌和子宫内膜癌的风险。本综述分析了发表的关于 RRBSO 前后 BRCA 基因突变携带者中 HRT 与癌症风险的相关数据。
方法:我们纳入了 1995 年至 2020 年 10 月期间发表的所有相关英文文献。通过在 PubMed 和 Cochrane 图书馆上搜索来确定来源。
结果:我们纳入了一项关于 BRCA 基因突变携带者卵巢癌风险和 HRT 的病例对照研究和一项回顾性队列研究,以及一项关于子宫内膜癌风险和 HRT 的病例对照研究。关于乳腺癌风险,我们纳入了一项关于 RRBSO 前后 BRCA 基因突变携带者的病例对照研究、一项病例对照研究、一项马尔可夫链决策模型、两项前瞻性队列研究和一项 RRBSO 后携带者的荟萃分析。对于卵巢癌,结果并不明确。对于乳腺癌,大多数研究未发现 HRT 相关的不良影响。然而,一些研究发现了与不同制剂和使用时长相关的风险修饰。
结论:尽管数据有限,但 HRT 似乎对 BRCA 基因突变携带者的癌症风险没有明显影响。在该人群中,不应该为了避免随后使用 HRT 而推迟 RRBSO。RRBSO 后应提供适当的 HRT,以避免因雌激素水平低导致的慢性疾病。然而,还需要更多关于不同制剂安全性的数据。
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