Hormone hullabaloo.

There’s been a lot of fuss about hormonal therapies increasing the risk of breast cancer in the general population. So it’s out of the question for those with BRCA mutations, right? Wrong. A large prospective observational study of almost 900 women with BRCA1 mutations across 80 centers in 17 countries demonstrates the safety of estrogen replacement following prophylactic bilateral oophorectomy. Specifically, the primary endpoint of new incidence of breast cancer was not at all associated with hormone replacement (HR 0.97), though an interesting observation was double the rate of breast cancer (at a whopping 22% at a median follow-up of 7 years) among the 40 women taking combined estrogen + progesterone. Why risk it at all? Because these women have it hard enough without piling on age-related comorbidities well before their time due to early-onset estrogen deprivation. TBL: Estrogen replacement following prophylactic oophorectomy in women with BRCA1 mutations appears safe, but maybe hold the progesterone for now. | Kotsopoulos, JAMA Oncol 2018