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Hormones and risk of breast and gynecological cancer

A systematic review

Hormone und das Risiko für Brustkrebs und gynäkologische Malignome

Ein systematisches Review

  • Review
  • Published:
Der Gynäkologe Aims and scope

Abstract

Background

Breast and gynecological cancers are often hormone dependent. The role of reproductive factors and endogenous hormones in tumorigenesis of these tumors has been investigated in numerous studies. Safety of oral contraception, hormone therapy during perimenopause or postmenopause or fertility treatment is of special interest for the information of women who are planning to use these therapies.

Objective

This article provides an update on the current knowledge on hormones and risk of breast and gynecological cancers.

Material and methods

We performed a systematic search in the Medline literature database through PubMed using the search terms “estrogen”, “testosterone”, “progesterone”, “gestagen”, “progestagen”, “hormone therapy”, “hormone treatment”, “hormonal contraception”, “ovulation induction”, “menopausal” “breast cancer”, “ovarian cancer”, “endometrial cancer” and “cervical cancer”. Articles published between 2010 and may 2016 were included.

Results and conclusion

Reproductive factors influence tumorigenesis of breast, ovarian and endometrial cancers. Oral contraception increases breast cancer risk but is protective against ovarian and endometrial cancers. The influence of ovarian hyperstimulation has been controversially discussed and no clear association with these hormone-dependent tumors has been observed. Hormone therapy in perimenopause and postmenopause and its influence on hormone dependent cancers is highly complex. Combined therapy containing estrogen and progestin (EPT) seems to increase breast cancer risk after use for approximately 5 years whereas estrogen only therapy (ET) does not or to a lesser extent. Hormone therapy increases ovarian cancer risk. Endometrial cancer risk is significantly increased by ET, whereas for EPT no significant effect has been observed. After diagnosis of breast and gynecological cancers hormone therapy is contraindicated as an increased risk of recurrence cannot be ruled out.

Zusammenfassung

Hintergrund

Mammakarzinome und gynäkologische Malignome sind häufig hormonabhängig. Die Rolle reproduktiver Faktoren bei der Karzinogenese dieser Tumoren wurde in zahlreichen Studien untersucht. Die Sicherheit oraler Kontrazeption, peri- und postmenopausaler Hormontherapie bzw. Ovulationsinduktion ist im Hinblick auf die Beratung von Frauen, die diese Therapien erwägen, von besonderem klinischem Interesse.

Ziel der Arbeit

Dieser Artikel soll eine aktuelle Übersicht über den Einfluss von Hormonen auf das Risiko für Mammakarzinome und gynäkologische Tumoren liefern.

Material und Methoden

Wir führten eine systematische Suche in der „Medline“ Literaturdatenbank über „Pubmed“ durch. Die Suchbegriffe lauteten „estrogen“, „testosterone“, „progesterone“, „gestagen“, „progestagen“, „hormone therapy“, „hormone treatment“, „hormonal contraception“, „ovulation induction“, „menopausal“ „breast cancer“, „ovarian cancer“, „endometrial cancer“ and „cervical cancer“. Eingeschlossen wurden Artikel, die zwischen 2010 und Mai 2016 publiziert worden sind.

Ergebnisse und Diskussion

Reproduktive Faktoren beeinflussen die Karzinogenese von Mamma-, Ovarial- und Endometriumkarzinomen. Orale Kontrazeptiva führen zu einer Erhöhung des Mammakarzinomrisikos, wirken aber protektiv auf das Risiko für Ovarial- und Endometriumkarzinome. Der Einfluss von Fertilitätstherapien wird kontrovers diskutiert, zwischen ovarieller Hyperstimulation und hormonabhängigen Tumoren war kein eindeutiger Zusammenhang festzustellen. Die Wirkungen peri- und postmenopausaler Hormontherapien (HT) auf hormonabhängige Karzinome sind hochkomplex. Kombinierte Östrogen-Gestagen-HTs (EPT) erhöhen das Mammakarzinomrisiko ab circa 5‑jähriger Anwendung, bei alleiniger Östrogentherapie (ET) ist dies nicht vorhanden bzw. weniger ausgeprägt. Eine HT erhöht das Risiko für Ovarialkarzinome. Eine ET erhöht das Risiko für Endometriumkarzinome signifikant, für eine EPT dagegen wurde kein signifikanter Effekt gezeigt. Für Patientinnen mit diagnostiziertem Mamma-, Ovarial- oder Endometriummalignom ist eine HT kontraindiziert, da sich ein erhöhtes Rezidivrisiko nicht ausschließen lässt.

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Correspondence to Susanne Schüler-Toprak.

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S. Schüler-Toprak, S. Seitz and O. Ortmann declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

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Schüler-Toprak, S., Seitz, S. & Ortmann, O. Hormones and risk of breast and gynecological cancer. Gynäkologe 50, 43–54 (2017). https://doi.org/10.1007/s00129-016-4004-0

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