HRT after ovarian cancer - query bank

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)

References:

  • British National Formulary. September 2009. Section 6.4.1.1 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.

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Date published: 16/08/2010

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