Addendum to: Archives of Gynecology and Obstetrics https://doi.org/10.1007/s00404-020-05682-4

The interdisciplinary S3 guideline, Peri- and postmenopause—diagnosis and interventions “of the association of the scientific medical societies in Germany (AWMF 015/062) was published in January 2020 and a short version in July 2020 (O. Ortmann et al. Arch Gynecol Obstet 302:763–777).

This guideline did not include the meta-analysis performed by the Collaborative Group on Hormonal Factors in Breast Cancer of data from prospective and retrospective observational and randomized studies on the association between peri- and postmenopausal hormone therapy (HT) and breast cancer risk. Since evidence from the meta-analysis of the Collaborative Group on Hormonal Factors in Breast Cancer is relevant, authors of the S3 guideline Peri- and postmenopause – diagnosis and interventions “ wrote an addendum on behalf of the steering committee that evaluates the data [1].

The authors of the S3 guideline propose that numbers quoted in Table 1 are appropriate for counseling women with climacteric symptoms. Five years of a sequential combined HT containing estrogen and progestin (EPT) started from the age of 50 years lead to 14 additional breast cancer cases per 1.000 women within the next 20 years. A continuously combined EPT causes 20 additional breast cancer cases whereas a HT containing only estrogen (ET) leads to 5 additional cases. These risk estimates are consistent with data published previously. Changes of statements or recommendations given in the S3 guideline, Peri- and postmenopause—diagnosis and interventions are, therefore, not required.

Table 1 Breast cancer risk associated with HT
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Table 2 includes numbers that are suitable to counsel women regarding the influence of the duration of a HT on breast cancer risk. Results from the meta-analysis show that an ET for up to 4 years does not increase breast cancer risk within the following 9 years (relative risk [RR] 1.07; 95% confidence interval [CI] 0.96–1.20). Also, sequential or continuously combined EPT for up to 4 years do not increase breast cancer risk within the following 9 years (RR 1.06; 95% CI 0.98–1.15) (Table 2). However, data from the meta-analysis indicate an increased breast cancer risk after 1 year of ET or EPT (Table 2). It is unclear whether this results from HT use or detection bias.

Table 2 Breast cancer risk by duration of HT
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