It is possible then, that while reducing the risk of recurrent breast cancers, an increased risk of both CAD and osteoporotic fractures might negate some of these chemotherapy-related gains. However, there are several small clinical series that have attempted to address this issue. The mean duration of HRT and clinical observation was approximately 3 years. One other small studies has reported similar findings. No studies have been published to date that analyze patients according to their estrogen receptor status.
Tamoxifen is another option to consider in the patient with previous breast cancer.
While it is currently used in many patients with invasive tumors, studies are ongoing for women with smaller, node-negative tumors as well as noninvasive tumors. In addition, tamoxifen is being evaluated as prophylaxis for those at risk for breast cancer. While primarily an estrogen antagonist, tamoxifen does have agonist properties as well, resulting in favorable lipid profiles, prevention of bone loss, and perhaps reduction of CAD risk. However, many women experience severe hot flushes with the drug, and there is an increased risk of endometrial cancer. There are some alternative treatments for management of hot flushes, such as clonidine, although not as effective as estrogen.