Experts reach consensus on HRT after breast cancer

Experts reach consensus on HRT after breast cancer | Image Credit: © Jfrank - © frank - stock.adobe.com.

An interdisciplinary panel of experts has highlighted the importance of informed decision making about whether to receive hormone replacement therapy (HRT) among breast cancer survivors with severe menopausal symptoms.¹

These investigators reached consensus about key HRT-related statements, including vaginal oestrogen being unlikely to increase the risk of breast cancer recurrence and systemic HRT increasing relapse risk in women with oestrogen receptor (ER) positive breast cancer. Investigators recommended patients taking HRT after breast cancer be enrolled in clinical trials.¹

“Based on our analysis of the available evidence, we think that some women may consider it reasonable to take HRT after breast cancer, after recognizing their own risk profile, if it meaningfully improves their quality of life,” said Jayant Vaidya, MBBS, professor at UCL Surgery & Interventional Science.¹

Panel composition and methodology

The study was conducted to assess data about the use of vaginal and systemic HRT following breast cancer and develop a consensus.² The panel included 19 clinicians with experience managing breast cancer, 5 of whom were General Practitioners, 5 gynecologists, 3 breast surgical oncologists, 5 breast medical oncologists, and 1 breast radiologist.

Methodology from the 2015 Clinical Consensus Statement Development Manual was used to create Expert Consensus Statements. Articles about vaginal and systemic hormone therapy were identified through literature searches of the Embase, Medline, and Cochrane Library databases.²

During an online meeting, panel members discussed opportunities to address controversial clinical issues, reduce variability in care, clarify evidence gaps, and improve quality of care. Following removal of duplicates and questions beyond the scope of the discussion, 37 questions were discussed, leading 38 statements to be developed.²

Consensus process and outcomes

Consensus was determined by panelists rating their level of agreement to each statement on a 5-point Likert score, with higher scores indicating stronger agreement. During a second meeting, discussions centered any statements that did not reach consensus in the first round, leading some statements to be reworded while others were rejected.²

Consensus, defined as 70% agreement or more, was reached for 34 statements. However, 1 of these statements was later rejected because of a lack of safety evidence. The highest level of consensus was reached for 6 of the remaining 33 statements.²

The statement that breast cancer survivors with genitourinary syndrome of the menopause may receive treatment with vaginal estrogen reached a consensus of 94%, with 82% of panelists agreeing this treatment is unlikely to increase breast cancer recurrence and death risks. The panel unanimously agreed patients were more likely to adhere to treatment if side effects are treated.²

Hormone therapy guidelines

Unanimous consensus was also reached for statements that menopause symptoms may be treated using systemic estrogen replacement in women receiving tamoxifen for ER positive breast cancer and that it is counterproductive to prescribe systemic estrogen in women being treated with aromatase inhibitors.²

Alongside initial decisions, statements were reached about continued hormone use. This included unanimous agreement that breast cancer patients may stop taking menopausal hormone therapy if the risks such as recurrence and death outweigh the benefits, symptoms have not improved, or for personal reasons.²

All panelists also agreed that patient’s medical history, views, preferences, and treatment goals should be considered when performing individualized care. Shared-decision making was highlighted as vital for ensuring patients make informed treatment decisions.²

Implications

Overall, these consensus statements were based on a synthesis of available evidence. Investigators noted evidence about the risks and benefits of hormone therapy after breast cancer is not definitive, indicating a need for further research.²

“What we really need now is a new clinical trial, such as the MENO-ABC trial that we’re proposing, to accurately quantify the risks and benefits in light of modern diagnostic methods and treatments, so that women and their clinicians have the complete information they need to make an informed decision,” said Vaidya.

References

1. Experts call for change of heart on hormone replacement therapy after breast cancer. University College London. September 30, 2025. Accessed October 1, 2025. https://www.eurekalert.org/news-releases/1100355.
2. Glynne S, Simon J, Branson A, et al. Menopausal hormone therapy for breast cancer patients: what is the current evidence? Menopause. 2025. doi:10.1097/GME.0000000000002627