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JNCI Journal of the National Cancer Institute 2000 92(4):328-332; doi:10.1093/jnci/92.4.328
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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

Ronald K. Ross, Annlia Paganini-Hill, Peggy C. Wan, Malcolm C. Pike

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 41/2 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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Relationship Between Long Durations and Different Regimens of Hormone Therapy and Risk of Breast Cancer
JAMA, June 25, 2003; 289(24): 3254 - 3263.
[Abstract] [Full Text] [PDF]


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CMAJHome page
K. H. Humphries and S. Gill
Risks and benefits of hormone replacement therapy: The evidence speaks
Can. Med. Assoc. J., April 15, 2003; 168(8): 1001 - 1010.
[Abstract] [Full Text] [PDF]


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Endocr. Rev.Home page
F. Labrie, V. Luu-The, C. Labrie, A. Belanger, J. Simard, S.-X. Lin, and G. Pelletier
Endocrine and Intracrine Sources of Androgens in Women: Inhibition of Breast Cancer and Other Roles of Androgens and Their Precursor Dehydroepiandrosterone
Endocr. Rev., April 1, 2003; 24(2): 152 - 182.
[Abstract] [Full Text] [PDF]


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Proc. Natl. Acad. Sci. USAHome page
H. K. Bhat, G. Calaf, T. K. Hei, T. Loya, and J. V. Vadgama
Critical role of oxidative stress in estrogen-induced carcinogenesis
PNAS, April 1, 2003; 100(7): 3913 - 3918.
[Abstract] [Full Text] [PDF]


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EndocrinologyHome page
T. M. Ahola, N. Alkio, T. Manninen, and T. Ylikomi
Progestin and G Protein-Coupled Receptor 30 Inhibit Mitogen-Activated Protein Kinase Activity in MCF-7 Breast Cancer Cells
Endocrinology, December 1, 2002; 143(12): 4620 - 4626.
[Abstract] [Full Text] [PDF]


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J. Med. Genet.Home page
D G R Evans and F Lalloo
Risk assessment and management of high risk familial breast cancer
J. Med. Genet., December 1, 2002; 39(12): 865 - 871.
[Abstract] [Full Text] [PDF]


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Cancer Epidemiol. Biomarkers Prev.Home page
C. M. Vachon, T. A. Sellers, R. A. Vierkant, F.-F. Wu, and K. R. Brandt
Case-Control Study of Increased Mammographic Breast Density Response to Hormone Replacement Therapy
Cancer Epidemiol. Biomarkers Prev., November 1, 2002; 11(11): 1382 - 1388.
[Abstract] [Full Text] [PDF]


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Mol. Endocrinol.Home page
P. M. Ismail, J. Li, F. J. DeMayo, B. W. O'Malley, and J. P. Lydon
A Novel LacZ Reporter Mouse Reveals Complex Regulation of the Progesterone Receptor Promoter During Mammary Gland Development
Mol. Endocrinol., November 1, 2002; 16(11): 2475 - 2489.
[Abstract] [Full Text] [PDF]


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Cancer Epidemiol. Biomarkers Prev.Home page
M. C. Pike, L. N. Kolonel, B. E. Henderson, L. R. Wilkens, J. H. Hankin, H. S. Feigelson, P. C. Wan, D. O. Stram, and A. M. Y. Nomura
Breast Cancer in a Multiethnic Cohort in Hawaii and Los Angeles: Risk Factor-adjusted Incidence in Japanese Equals and in Hawaiians Exceeds that in Whites
Cancer Epidemiol. Biomarkers Prev., September 1, 2002; 11(9): 795 - 800.
[Abstract] [Full Text] [PDF]


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Cancer Epidemiol. Biomarkers Prev.Home page
M. D. Holmes, M. N. Pollak, and S. E. Hankinson
Lifestyle Correlates of Plasma Insulin-like Growth Factor I and Insulin-like Growth Factor Binding Protein 3 Concentrations
Cancer Epidemiol. Biomarkers Prev., September 1, 2002; 11(9): 862 - 867.
[Abstract] [Full Text] [PDF]


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EndocrinologyHome page
T. M. Ahola, T. Manninen, N. Alkio, and T. Ylikomi
G Protein-Coupled Receptor 30 Is Critical for a Progestin-Induced Growth Inhibition in MCF-7 Breast Cancer Cells
Endocrinology, September 1, 2002; 143(9): 3376 - 3384.
[Abstract] [Full Text] [PDF]


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JCOHome page
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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JAMAHome page
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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JAMAHome page
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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Cancer Epidemiol. Biomarkers Prev.Home page
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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Am. J. Pathol.Home page
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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CMAJHome page
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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ANN INTERN MEDHome page
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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JAMAHome page
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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JCOHome page
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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BMJHome page
J M Dixon
Hormone replacement therapy and the breast
BMJ, December 15, 2001; 323(7326): 1381 - 1382.
[Full Text] [PDF]


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Cancer Epidemiol. Biomarkers Prev.Home page
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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J. Nutr.Home page
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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BMJHome page
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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ANN INTERN MEDHome page
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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Mol. Cell. Biol.Home page
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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JNCI J Natl Cancer InstHome page
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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The OncologistHome page
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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