January 8, 2002
Hormone replacement therapy and cancer: Balancing safety and quality
of life
Women who have cancer
Karen Pollard, RN, NP, (right) discusses HRT with Evelyn Aquavira, a breast cancer patient.
Karen Pollard, RN, NP, a nurse practitioner who cares for patients with breast cancer, agrees that these patients generally are not candidates for HRT. Nevertheless, she says, there are exceptions and alternatives. "As nurse practitioners, we collaborate with physicians to evaluate each woman's risk tolerance, explain the risks and benefits of estrogen replacement in her case, and help her make a personal decision that balances safety with quality of life."
Some of Pollard's patients enter menopause because they have received chemotherapy. Others who were taking HRT have to stop because of a breast cancer diagnosis. Still others are taking tamoxifen (Nolvadex), a drug that blocks estrogen in the breast, or a newer drug, raloxifene (Evista), which can create menopausal symptoms such as hot flashes. These "selective estrogens" may be used to prevent breast cancer in women at risk and to prevent the spread of cancer in women who have already been treated.
Menopausal symptoms can be difficult for any woman, says Pollard, but for a woman with cancer, the challenges may multiply. "The symptom that most affects quality of life for my patients is vaginal dryness," says Pollard. "The walls of the vagina grow thin and sometimes this can cause significant discomfort during sexual activity. For some women with breast cancer, a medication called Estring, which releases a low dose of estrogen through a vaginal insert, can bring relief. "In collaboration with physicians, I have recommended this for a few patients," she continues. "It gives a steady dose instead of the intermittent doses offered by vaginal creams, and the blood levels of estrogen in the body are very low."
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