Treatment of estrogen deficiency symptoms in women surviving breast cancer

Definition of the Problem Increased patient awareness, mammography screening, and the use of adjuvant therapy have resulted in earlier diagnosis of breast cancer and a greater probability of long-term survival. Consequently, a large and increasing number of women who have survived breast cancer are alive. In two-thirds of these patients, the onset of menopause occurred prior to the diagnosis of breast cancer. In many of the others, ovarian failure resulted from adjuvant chemotherapy or occurred spontaneously. A large fraction of these women currently experience symptoms of estrogen deficiency and/or can expect to develop premature heart disease and osteoporosis. At present, estrogen replacement therapy is considered by many to be contraindicated in these menopausal breast cancer survivors since estrogens may accelerate the growth of occult metastases. How to treat the range of problems related to estrogen deficiency in these patients is largely unexplored at present. Both the short-term effects of estrogen deficiency, such as vasomotor instability and urogenital atrophy, and the long-term consequences, such as osteoporosis and heart