Hormones are the main regulators of the development and function of the normal breast and relevant for several treatment modalities in many women with breast cancer. Studies on exogenously added steroids and their effects on the breast in menopausal women have resulted in a global change in the perception of many aspects of this topic. Especially, the publication of data on breast cancer risk related to hormone therapy has caused a lot of anxiety in women.

This special issue reviews some aspects of this important topic. The publication on the effect of menopausal hormone therapy on the breast summarizes the clinical effects in menopausal women with or without the diagnosis of breast cancer [1]. Breast cancer risk following hormone replacement treatment (HRT) has been shown to be unchanged or slightly increased depending on the type of substance (estrogens and progestins) and the duration of use. In BRCA mutation carriers, who are undergoing risk-reducing bilateral salpingo-oophorectomy without previous breast cancer, HRT can be offered up to the age of natural menopause. However, the use of HRT is contraindicated in women with a history of in situ or invasive breast cancer.

Many women with breast cancer often suffer from severe menopausal symptoms and often choose to take phytoestrogens. The literature regarding the effect of phytoestrogens for menopausal vasomotor symptoms after breast cancer was reviewed in a paper in this issue [2]. Randomized controlled trials have investigated several products containing phytoestrogens. When compared to placebo, these studies did not demonstrate a benefit regarding frequency or severity of menopausal symptoms. The authors suggest to further investigate different herbal preparations to find new treatment options for symptomatic menopausal breast cancer patients.

Several studies demonstrated that breast cancer risk was not elevated after estrogen-only treatment but that the increase in risk was dependent on the progesterone component. In this issue, the third paper relates to the progesterone receptor membrane component 1 (PGRMC1) [3]. Interestingly, all available synthetic progestogens (but not progesterone) affect the proliferation of breast cancer cells in a dose- and time-dependent manner. These effects are more prominent in the presence of the multifunctional receptor PGRMC1 that is regarded as a mediator for hormonal action in the breast. It appears from preclinical data that this membrane-bound receptor has the potential to predict the prognosis of breast cancer patients and may also serve as a possible predictive marker for breast cancer risk during HRT.

The author has no conflicts of interest to declare.

1.
Sourouni
M
,
Kiesel
L
Menopausal hormone therapy and the breast: review of clinical studies
2.
Vogel
M
,
Franik
S
,
Kiesel
L
Phytoestrogen treatment for menopausal vasomotor symptoms after breast cancer
3.
Ruan
X
,
Mueck
AO
Clinical importance of PGRMC1 in hormone responsive breast cancer
© 2023 S. Karger AG, Basel
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2023