Management of menopause in women with breast cancer.

It is now well established that replacement therapy with estrogen is an effective tool to manage menopausal symptoms. There is also increasing evidence that hormone replacement therapy has beneficial effects on the long-term consequences of estrogen deficiency, such as osteoporosis and ischemic heart disease. However, breast cancer patients have been traditionally denied the beneficial effects of hormone replacement therapy (HRT) because of the belief that renewed hormonal exposure would accelerate the growth of occult breast cancer or facilitate breast carcinogenesis. Based on new data and reanalysis of old data, a reappraisal of this belief has recently been proposed. Reports on a small number of patients who did receive HRT with no apparent effect on their breast disease warrant large-scale prospective studies on this issue. Meanwhile, pharmacological and "natural" alternatives to hormonal treatment are also available for breast cancer patients.