Question 68
Dear Doctor N,
Over two months ago, I had a complete hysterectomy due to endometrial cancer. My ONC / GYN does not think it necessary to use hormone therapy at all. In fact, because he feels all the cancer was successfully removed, there was no follow-up treatments at all. I do have to go for check-ups every four months for the next five years. My question: Prior to the problem with the endometrial cancer, I used a natural progesterone cream. Would there be any advantage to renewing usage of the progesterone? Some days, I feel it would be beneficial especially for my bones and possible protection against osteoporosis. Your comment would be greatly appreciated.
Reply:
I think that your physician's attitude is somewhat cavalier. The research confirms that in women like yourself with successfully treated endometrial cancer there is no reason to withhold HRT. There is no evidence that HRT will increase risk for reoccurrence or decrease the disease free interval.
In denying you treatment your physician is unnecessarily exposing you toa diminished quality of life and longevity associated with hormone deprivation. I do not believe that progesterone cream is of any value for you.
I have included the summaries of 2 relevant medical articles.
Dr N
Abstract
Estrogen replacement therapy: is previously treated cancer a contraindication?
Author:
Creasman WT
Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston.
Obstet Gynecol 1991 Feb;77(2):308-12
Article Number: UI91110222
Abstract: The benefits of estrogen replacement therapy in preventing vasomotor symptoms, osteoporosis, and cardiovascular disease are well documented. Although estrogen is said to be contraindicated in patients successfully treated for endometrial and breast cancer, there are no data to substantiate this admonition. Experience suggests that it can be used safely in patients treated previously for endometrial cancer. Although there is little or no experience with estrogen use in the woman treated previously for breast cancer, circumstantial evidence suggests that it is not contraindicated in all such cases. Informed consent, patient desires, and risk-benefit considerations must enter into the decision to use estrogen in these patients.
Abstract
Estrogen replacement in surgical stage I and II endometrial cancer survivors.
Authors:
Chapman JA , DiSaia PJ , Osann K , Roth PD , Gillotte DL , Berman ML
Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, USA.
Am J Obstet Gynecol; 175(5):1195-200 1996
Article Number: UI97097946
Abstract: OBJECTIVE: Our purpose was to evaluate our experience with estrogen replacement in women with a history of early-stage endometrial cancer and to determine whether it increased the risk for recurrence or death. STUDY DESIGN: A retrospective review was performed of 123 women with surgical stage I and II endometrial adenocarcinoma treated between 1984 and 1994; 62 had received estrogen replacement therapy after cancer therapy. Sixty-one women received no estrogen. Variables analyzed included age parity, surgical stage, grade, depth of myometrial invasion, presence of intercurrent illnesses, duration of follow-up,and duration of estrogen replacement, if applicable. Outcome variables assessed included recurrence rate, time to recurrence, and disease-free interval.
RESULTS: The estrogen replacement therapy group had earlier stage disease (p =0.04) and less severe depth of invasion (p = 0.003); however, the total number of deaths in each group was not significantly different. The disease-free survival in the estrogen replacement therapy group did not differ significantly compared with those not receiving estrogen replacement therapy. The data are suggestive of improved disease-free survival in the estrogen replacement therapy group, which may be related to differences in age, stage, grade, and depth of invasion. The overall recurrence rate was 6.5%, with an overall death rate of 1.6%.
CONCLUSIONS: There is no evidence to suggest that estrogen decreased the disease-free interval or increased the risk for recurrence in early-stage disease.