© 2000 by Oxford University Press
Journal of the National Cancer Institute, Vol. 92, No. 4, 328-332,
February 16, 2000
© 2000 Oxford University Press
REPORTS |
Effect of Hormone Replacement Therapy on Breast Cancer Risk: Estrogen Versus Estrogen Plus Progestin
Affiliation of authors: University of Southern California/Norris Comprehensive Cancer Center, Los Angeles.
Correspondence to: Ronald K. Ross, M.D., University of Southern California/Norris Comprehensive Cancer Center, 1441 Eastlake Ave., Rm. 8302B, Los Angeles, CA 90089-9181 (e-mail: ross_r{at}ccnt.hsc.usc.edu).
BACKGROUND: Hormone replacement therapy (HRT) given as unopposed estrogen
replacement
therapy (ERT) gained widespread popularity in the United States in the 1960s and 1970s. Recent
prescribing practices have favored combination HRT (CHRT), i.e., adding a progestin to estrogen
for
the entire monthly cycle (continuous combined replacement therapy [CCRT]) or a
part of
the cycle (sequential estrogen plus progestin therapy [SEPRT]). Few data exist on the
association between CHRT and breast cancer risk. We determined the effects of CHRT on a
woman's risk of developing breast cancer in a population-based, case-control study.
METHODS: Case subjects included those with incident breast cancers diagnosed over 4
years in Los Angeles County, CA, in the late 1980s and 1990s. Control subjects were
neighborhood
residents who were individually matched to case subjects on age and race. Case subjects and
control
subjects were interviewed in person to collect information on known breast cancer risk factors as
well
as on HRT use. Information on 1897 postmenopausal case subjects and on 1637 postmenopausal
control subjects aged 55-72 years who had not undergone a simple hysterectomy was analyzed.
Breast
cancer risks associated with the various types of HRT were estimated as odds ratios (ORs) after
adjusting simultaneously for the different forms of HRT and for known risk factors of breast
cancer. All P values are two-sided. RESULTS: HRT was associated with a 10%
higher
breast cancer risk for each 5 years of use (OR5 = 1.10; 95% confidence
interval [CI] = 1.02-1.18). Risk was substantially higher for CHRT use (OR5 = 1.24; 95% CI = 1.07-1.45) than for ERT use (OR5
= 1.06; 95% CI = 0.97-1.15). Risk estimates were higher for SEPRT (OR5 = 1.38; 95% CI = 1.13-1.68) than for CCRT (OR5
=
1.09; 95% CI = 0.88-1.35), but this difference was not statistically significant. Conclusions: This study provides strong evidence that the addition of a progestin to HRT
enhances
markedly the risk of breast cancer relative to estrogen use alone. These findings have important
implications for the risk-benefit equation for HRT in women using CHRT.
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R. T. Chlebowski, N. Col, E. P. Winer, D. E. Collyar, S. R. Cummings, V. G. Vogel III, H. J. Burstein, A. Eisen, I. Lipkus, and D. G. Pfister American Society of Clinical Oncology Technology Assessment of Pharmacologic Interventions for Breast Cancer Risk Reduction Including Tamoxifen, Raloxifene, and Aromatase Inhibition J. Clin. Oncol., August 1, 2002; 20(15): 3328 - 3343. [Abstract] [Full Text] [PDF] |
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Writing Group for the Women's Health Initiative In Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women: Principal Results From the Women's Health Initiative Randomized Controlled Trial JAMA, July 17, 2002; 288(3): 321 - 333. [Abstract] [Full Text] [PDF] |
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S. W. Fletcher and G. A. Colditz Failure of Estrogen Plus Progestin Therapy for Prevention JAMA, July 17, 2002; 288(3): 366 - 368. [Full Text] [PDF] |
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P. A. Newcomb, L. Titus-Ernstoff, K. M. Egan, A. Trentham-Dietz, J. A. Baron, B. E. Storer, W. C. Willett, and M. J. Stampfer Postmenopausal Estrogen and Progestin Use in Relation to Breast Cancer Risk Cancer Epidemiol. Biomarkers Prev., July 1, 2002; 11(7): 593 - 600. [Abstract] [Full Text] [PDF] |
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S. M. Hyder The Role of Steroid Hormones on the Regulation of Vascular Endothelial Growth Factorm Am. J. Pathol., July 1, 2002; 161(1): 345 - 346. [Full Text] [PDF] |
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K. I. Pritchard, H. Khan, and M. Levine Clinical practice guidelines for the care and treatment of breast cancer: 14. The role of hormone replacement therapy in women with a previous diagnosis of breast cancer Can. Med. Assoc. J., April 1, 2002; 166(8): 1017 - 1022. [Abstract] [Full Text] [PDF] |
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N. C. Dolan, K. Freund, and J. Walsh Update in Women's Health Ann Intern Med, March 19, 2002; 136(6): 453 - 462. [Full Text] [PDF] |
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C.-L. Chen, N. S. Weiss, P. Newcomb, W. Barlow, and E. White Hormone Replacement Therapy in Relation to Breast Cancer JAMA, February 13, 2002; 287(6): 734 - 741. [Abstract] [Full Text] [PDF] |
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G. Ursin, C.-C. Tseng, A. Paganini-Hill, S. Enger, P. C. Wan, S. Formenti, M. C. Pike, and R. K. Ross Does Menopausal Hormone Replacement Therapy Interact With Known Factors to Increase Risk of Breast Cancer? J. Clin. Oncol., February 1, 2002; 20(3): 699 - 706. [Abstract] [Full Text] [PDF] |
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J M Dixon Hormone replacement therapy and the breast BMJ, December 15, 2001; 323(7326): 1381 - 1382. [Full Text] [PDF] |
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I. T. Gram, G. Ursin, D. V. Spicer, and M. C. Pike Reversal of Gonadotropin-releasing Hormone Agonist Induced Reductions in Mammographic Densities on Stopping Treatment Cancer Epidemiol. Biomarkers Prev., November 1, 2001; 10(11): 1117 - 1120. [Abstract] [Full Text] [PDF] |
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M. J. Messina and C. L. Loprinzi Soy for Breast Cancer Survivors: A Critical Review of the Literature J. Nutr., November 1, 2001; 131(11): 3095S - 3108. [Abstract] [Full Text] [PDF] |
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R. A Wiseman, G. Jasienska, and I. Thune Lifestyle, progesterone, and risk of breast cancer BMJ, October 27, 2001; 323(7319): 1002 - 1002. [Full Text] |
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J. M. Grossman and C. H. MacLean Quality Indicators for the Management of Osteoporosis in Vulnerable Elders Ann Intern Med, October 16, 2001; 135(8_Part_2): 722 - 730. [Full Text] [PDF] |
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A. K. C. Teo, H. K. Oh, R. B. Ali, and B. F. L. Li The Modified Human DNA Repair Enzyme O6-Methylguanine-DNA Methyltransferase Is a Negative Regulator of Estrogen Receptor-Mediated Transcription upon Alkylation DNA Damage Mol. Cell. Biol., October 15, 2001; 21(20): 7105 - 7114. [Abstract] [Full Text] [PDF] |
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V. C. Jordan, S. Gapstur, and M. Morrow Selective Estrogen Receptor Modulation and Reduction in Risk of Breast Cancer, Osteoporosis, and Coronary Heart Disease J Natl Cancer Inst, October 3, 2001; 93(19): 1449 - 1457. [Abstract] [Full Text] [PDF] |
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K. I. Pritchard Hormone Replacement in Women with a History of Breast Cancer Oncologist, August 1, 2001; 6(4): 353 - 362. [Abstract] [Full Text] [PDF] |
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