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CMAJ
CMAJ - June 2, 1998JAMC - le 2 juin 1998

More on breast cancer guidelines

CMAJ 1998;158:1426

See response from: M. McGregor
On behalf of the Society of Obstetricians and Gynaecologists of Canada (SOGC), I offer congratulations on these guidelines. I am sure they will constitute a useful resource for obstetrician-gynecologists, who see many women with breast cancer in their practices.

I was a little concerned that there was no discussion of the role and appropriateness of hormone replacement therapy (HRT) after breast cancer in postmenopausal women. There is no doubt that this remains a controversial issue about which there is little prospective scientific information. Current estimates suggest that 100 000 North American women are cured of breast cancer every year, many of whom become prematurely menopausal because of adjuvant chemotherapy. The loss of ovarian function has an adverse effect on quality of life for many of these women and significantly accelerates osteoporosis and cardiovascular disease in others. The National Cancer Institute in the US recently initiated a randomized controlled trial to evaluate the appropriateness of HRT after breast cancer to treat these problems.

The SOGC has just published a policy statement on this topic.1 It is our position that after treatment of breast cancer, all women should receive expert personal counselling that covers prognostic factors, immediate quality-of-life issues related to estrogen deficiency, risk factors for future osteoporotic fracture and cardiovascular disease, and options for symptom control and disease prevention. It is our hope that more prospective clinical data on which to base an evaluation of the role of HRT after breast cancer will be available for future iterations of these clinical practice guidelines.

Robert L. Reid, MD
President
Society of Obstetricians and
Gynaecologists of Canada
Department of Obstetrics and
Gynaecology
Queen's University
Kingston General Hospital
Kingston, Ont.

Reference

  1. Working Group on Breast Cancer and Hormone Replacement Therapy, Society of Obstetricians and Gynaecologists of Canada. Hormone replacement therapy: an update. The benefits of hormone replacement therapy and counselling issues related to breast cancer. J Soc Obstet Gynaecol Can 1998;20:490-6.

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