Hormone replacement therapy in healthy BRCA1 and 2 mutation carriers after risk-reducing salpingo-oophorectomy: a 5 Ws and 2 Hs practitioner toolkit.

Risk-reducing salpingo-oophorectomy offered to carriers of germline BRCA1 or BRCA2 variants induces premature surgical menopause, whose consequences hormone replacement therapy aims to correct.

Managing menopausal symptoms in healthy women carrying a germline BRCA1 or BRCA2 variant is particularly challenging after risk-reducing salpingo-oophorectomy. This preventive surgery is recommended because it lowers ovarian cancer risk, halves breast cancer risk and decreases all-cause mortality, but it induces premature menopause with genuine health consequences. The authors note that hormone replacement therapy remains little used in this population, mainly because of patients' and physicians' concerns about its oncological safety. Current evidence, in their reading, suggests that a short course of hormone replacement therapy does not increase breast cancer risk in carriers after risk-reducing salpingo-oophorectomy, and that it can therefore be offered until the age of natural menopause; the review is structured around five W questions (why, when, who, what, where) and two H questions (how, how much) intended to guide prescribing.

Synthesis written by Geno'X. For the full original abstract, please refer to the source publication.

The value of this paper is to name an obstacle we all meet in clinic: reluctance to prescribe hormone replacement therapy after risk-reducing salpingo-oophorectomy comes at least as much from the prescriber as from the patient, and that reluctance weighs on acceptance of the risk-reducing surgery itself. What the format offers stops there, since this is a narrative review with no documented search strategy and no quantified risk estimate, no distinction between BRCA1 and BRCA2, no maximum duration and no comparison of oestrogen-only versus combined therapy, that is, none of the elements that actually determine the prescription. Use it to open the conversation and reassure on principle, not to settle a regimen.

Analysis by Dr Thibaut Benquey