Cancer surveillance during HRT.

The principal cancer sites in women are the following in order of frequency: breast, colorectal, lung, uterus and ovary. Thus, all women during the climacterium have a potential risk of developing any of these cancers. This implies that appropriate means for prevention and early diagnosis must be established. Results from trials studying the association between hormone replacement therapy (HRT) and breast cancer are not conclusive. There is some evidence of a minimal increased cancer induction risk when using high and long-term HRT dosages, though we must await further studies combining different kinds, dosages and routes of administration of the hormones which are currently being prescribed. Breast surveillance must include medical history, physical examination, an annual mammography, as well as follow-up of all previously detected breast pathology through both physical examination and mammography. One should bear in mind that HRT may increase breast parenchymal density and lower mammography sensitivity. HRT seems to protect against colorectal cancer. However, because of the high frequency of this disease among women over 50 years of age, an annual stool test for occult blood should be performed. Endometrial cancer risk is much increased after HRT administration, still persisting after estrogen wash-out. This risk can be prevented by giving an opposed progestogen. Some diagnostic assessments, especially echography and endometrial biopsy, are recommended in certain cases such as patients with metrorrhagia or with a history of suspected cancer. There do not seem to be any demonstrated adverse effects on ovary and cervix due to HRT, although an annual Pap smear for cervical cancer screening is currently recommended.(ABSTRACT TRUNCATED AT 250 WORDS)