In view of the growing number of postmenopausal women using estrogen replacement therapy for the prevention of acute and chronic consequences of hypoestrogenism, any possible associations between hormone therapy and manifestations of gynecologic cancer are an issue of increasing importance. We reviewed the published literature to evaluate the impact of estrogen replacement therapy on the occurrence of gynecologic malignancies including breast cancer. The tumor growth of ovarian, cervical, vaginal, and vulvar neoplasias is not fundamentally influenced by hormone therapy. However, long-term replacement therapy may be associated with an increased incidence of endometrial hyperplasia and even of neoplasia. This increased risk is related to the duration and cumulative dose of estrogen therapy. Addition of progestin probably reduces the risk of endometrial cancer to that observed in the general population. With regard to the relationship between hormone replacement therapy and the incidence of breast cancer, available epidemiologic data are contradictory. While therapy of less than 5 years appears not to be associated with an increased risk, long-term use may be related to a small but significant increase in the risk of developing breast cancer. It is important to note that the cyclic addition of a progestin to estrogen replacement does not affect this risk. After discontinuation of hormone replacement the increased relative risk returns to that of non-users. In conclusion, when considering estrogen replacement therapy for a postmenopausal woman, a slightly increased risk of developing breast cancer and the need to add progestin for protection of the endome-trium need to be mentioned. Bearing this in mind, the benefits of estrogen therapy in terms of a better quality of life and perhaps of a disease-free prolongation of life justify a wide use of hormonal preparations.
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