Question: I am looking at the use of HRT in women with a diagnosis of ovarian cancer. Is it safe to use?
Please note: the search for this response was carried out over 1 year ago. Eligible users may request an update of the evidence by submitting a new Clinical Query here.
Answer: A systematic review of the impact on survival among women with ovarian cancer on HRT published in 2004 (Hopkins) found one randomized trial and two observational studies. They report that:
“Due to methodological heterogeneity of the included studies, results have not been pooled in a meta-analysis. The randomized trial presented differences between the intervention and control groups on median overall survival (44 months vs. 34 months/HRT vs. No-HRT) and disease-free survival (34 months vs. 27 months/HRT vs. No-HRT) that were not significant. Similarly, there were nonsignificant differences in survival and recurrence rates in the two included cohort studies.”
A more recent review article of hormone replacement after gynaecological cancer (Singh) has assessed the same three studies, plus another case-series and a more recent (2006) cohort study. The authors report:
“Post-treatment, none of the published studies has shown an adverse effect of HRT on ovarian cancer patients”
(Evidence level 1b)
The British National Formulary lists oestrogen-dependent cancer as a contraindication to oestrogens for HRT.
(Evidence level IV)
- British National Formulary. September 2009. Section 18.104.22.168 Oestrogens and HRT
- Hopkins ML. Fung MF. Le T. Shorr R. Ovarian cancer patients and hormone replacement therapy: a systematic review. [Review] [38 refs] Gynecologic Oncology. 92(3):827-32, 2004 Mar. Abstract
- Singh P. Oehler MK. Hormone replacement after gynaecological cancer. [Review] [69 refs] Maturitas. 65(3):190-7, 2010 Mar. Abstract
Search date: August 2010
Classification of evidence levels
Ia Evidence obtained from meta-analysis of randomised controlled trials.
Ib Evidence obtained from at least one randomised controlled trial.
IIa Evidence obtained from at least one well-designed controlled study without randomisation.
IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.
III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.
IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.
This clinical query answer was produced following the clinical query protocol as described here.
The RCOG will not be liable for any special or consequential damages arising from the use or reliance on information contained within the Query Bank.