Hormone replacement therapy and beyond. The clinical challenge of menopausal symptoms in breast cancer survivors.

Early diagnosis and refinements in anti-cancer regimens have significantly reduced the mortality rate from breast cancer. In fact, breast cancer survivors represent the largest group of cancer survivors In the United States. Most breast cancer cases are diagnosed after menopause and those women diagnosed before menopause become menopausal as a result of chemotherapy. Thus a significant number of breast cancer survivors must also contend with symptoms and consequences of menopause, particularly hot flashes, night sweats, mood disorders, and bone loss. The available data suggest a possible role for hormone therapy (estrogen alone, or, combination estrogen/progestin) in the management of menopausal symptoms in select breast cancer survivors. Well-designed controlled trials are needed in this population. In the meantime, some nonhormone therapies may be options for management of hot flashes, vaginal dryness, and osteoporosis.