1. WEEK 3 EBCR – 8A Sri Puspita Amalia NP Lingga S Rienna Diansari Harsya DG Tutor : dr.Dewi Friska

2. Cases • Mrs. X, 60 years old, complains a lump in her right breast since 4 weeks ago. The lump is not painful and getting bigger over time. It is fixated and has flat surface. There are some changes on her breast skin too. Mrs. X has been menopause since 7 years ago, and with the recommendation of her previous doctor, she has been taking estrogen therapy to prevent heart disease and osteoporosis. • Her elder sister died 2 months ago from breast cancer and had a history of estrogen-progestin therapy. • She asked, whether the hormonal therapy could induce breast cancer?

3. Background • In US, 2011 230,480 new cases of invasive breast cancer & 57,650 new cases of non-invasive (in situ) breast cancer. • In Indonesia  The second most common female cancer • Risk factor exposure to estrogen (hormone replacement therapy), family history, diet, oral contraceptive, breast changes, etc. • Theory  Estrogen and progesterone receptors, present in some breast cancers, are nuclear hormone receptors that promote DNA replication and cell division when the appropriate hormones bind to them. Vogel VG. Breast Cancer. 2008. Merck & Co. Available at: http://www.merckmanuals.com/professional/gynecology_and_obstetrics/breast_disorders/breast_cancer.html Tjindarbumi D, Mangunkusumo R. Cancer in Indonesia, Present and Future. Jpn J Clin Oncol 2002; 32.

4. ACQ PICO

5. METHODS Search Strategy

6. Selection Criteria

10. VIA

11. RESULTS 1.Shah et al1 2Shah NR, Borenstein J, Dubois RW. Postmenopausal hormone therapy and breast cancer: a systematic review and meta-analysis. Menopause. 2005; 12 (6); 668-78

12. 2.Greiseret al2 1Greiser CM, Greiser EM, Doren M. Menopausal hormone therapy and risk of breast cancer: a meta-analysis of epidemiological studies and RCT. Human Reproduction Update. 2005; 11 (6); 561-73

13. DISCUSSION Results The result of this two studies has a consistency with almost all previous studies, that using postmenopausal hormonal therapy have a higher risk of breast cancer. Combined EPT is higher than ET. Those study also show that after 1 year discontinuation of PHT, the risk of breast cancer is decrease. But about the risk of breast cancer after discontinuation of PHT, still needs further analysis.

14. Strength and Limitations • searched from some databases such as PubMed, Cochrane, and Ebsco. • recent studies, last 10 years and the studies are systematic review and meta-analyses. • validity of that two studies were assessed by sistematic review worksheet from Central Evidence Based Medicine (CEBM).3 • The studies relevance with our clinical questions • systematic reviews are consist only with English language • just use a computer search. We didn’t do a hand searching or unpublished studies

15. CONCLUSION Those both appraised article are suitable and not so different from our case. Because the patient of the studies and our case are same characteristic, so these studies can be applied to our patient.

16. THANK YOU