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Postmenopausale Hormontherapie und Mammakarzinomrisiko

Ein Update

Postmenopausal hormone therapy and the risk of breast cancer – an update

 

  • Leitthema
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Der Gynäkologe Aims and scope

Zusammenfassung

Mehrere Beobachtungs- und randomisierte klinische Studien haben gezeigt, dass die Durchführung einer längerfristigen postmenopausalen Hormontherapie („hormone therapy“, HT) mit einem erhöhten Mammakarzinomrisiko einhergeht; dieses Risiko ist bei Anwendung einer kombinierten Östrogen-Gestagen-Behandlung höher. Der Zusammenhang zwischen HT und Mammakarzinomrisiko scheint umso stärker zu sein, je länger die Therapie durchgeführt wird. Sind mehr als 5 Jahre nach Beendigung der HT vergangen, so ist nicht mehr von einem erhöhten Risiko auszugehen. Die alleinige Östrogentherapie scheint im Vergleich zur kombinierten Östrogen-Gestagen-Behandlung mit einem geringeren Mammakarzinomrisiko einherzugehen; aufgrund des erhöhten Endometriumkarzinomrisikos lässt sie sich jedoch nur bei Frauen mit vorangegangener Hysterektomie durchführen. Entscheidet man sich in der klinischen Praxis für die Durchführung einer HT, so sollte diese so kurz wie möglich erfolgen. Die ausführliche Aufklärung der Patientin über Risiken und Nutzen ist von besonderer Wichtigkeit.

Abstract

Numerous observational and randomized clinical studies suggest that long-term postmenopausal hormone therapy may be associated with an increased risk of invasive breast cancer. That risk seems to be elevated especially when combined estrogen-progestin therapy (EPT) is used. The longer EPT has been prescribed, the more this risk becomes evident. Five years following cessation of EPT, the risk of invasive breast cancer is thought to have returned to normal values. Furthermore, the breast cancer risk associated with estrogen-only therapy (ET) seems to be lower than with combination EPT. However, ET is recommended only among patients having undergone hysterectomy due to an elevated risk of endometrial cancer. In clinical practice the duration of both EPT and ET should be limited. Furthermore, illustrating the potential benefits and risks is of particular importance when counseling patients.

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  1. Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Münster, Albert-Schweitzer Str. 33, 48149, Münster, Deutschland

    C. Liedtke & L. Kiesel

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Correspondence to C. Liedtke.

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Liedtke, C., Kiesel, L. Postmenopausale Hormontherapie und Mammakarzinomrisiko. Gynäkologe 41, 865–873 (2008). https://doi.org/10.1007/s00129-008-2212-y

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