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Published in: Breast Cancer Research 5/2008

Open Access 01-10-2008 | Research article

Menopausal hormone therapy in relation to breast cancer characteristics and prognosis: a cohort study

Authors: Lena U Rosenberg, Fredrik Granath, Paul W Dickman, Kristjana Einarsdóttir, Sara Wedrén, Ingemar Persson, Per Hall

Published in: Breast Cancer Research | Issue 5/2008

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Abstract

Introduction

Menopausal hormone therapy has been reported to increase the risk of certain subtypes of breast cancer and to be associated with a favorable survival. These associations could either be due to an increased mammographic surveillance or to a biological effect. We assessed these associations in a Swedish cohort of postmenopausal breast cancer patients holding information on mammographic examinations, menopausal hormone therapy use, other breast cancer risk factors, and cancer treatment.

Methods

We analyzed 2,660 postmenopausal women aged 50 to 74 years, diagnosed with invasive breast cancer in 1993 to 1995 and followed until the end of 2003 (median follow-up, 9 years and 3 months). We assessed the influence of hormone therapy before diagnosis on tumor characteristics and breast cancer-specific survival. We analyzed hormone therapy before diagnosis by regimen (estrogen–progestin therapy or estrogen alone therapy), recency (current or past), and duration of use (<5 years or ≥ 5 years).

Results

Current use, but not past use, compared with never use of hormone therapy before diagnosis seemed to be associated with tumors of low grade and with improved breast cancer-specific survival. The associations were stronger with longer duration, but did not vary significantly by regimen. The favorable survival among current users of hormone therapy was only partly explained by differences in available tumor characteristics and mammographic surveillance.

Conclusions

We conclude that current menopausal hormone therapy, especially long term, is associated with favorable tumor characteristics and survival.
Appendix
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Literature
1.
go back to reference Beral V: Breast cancer and hormone-replacement therapy in the Million Women Study. Lancet. 2003, 362: 419-427. 10.1016/S0140-6736(03)14596-5.CrossRefPubMed Beral V: Breast cancer and hormone-replacement therapy in the Million Women Study. Lancet. 2003, 362: 419-427. 10.1016/S0140-6736(03)14596-5.CrossRefPubMed
2.
go back to reference Chlebowski RT, Hendrix SL, Langer RD, Stefanick ML, Gass M, Lane D, Rodabough RJ, Gilligan MA, Cyr MG, Thomson CA, Khandekar J, Petrovitch H, McTiernan A: Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women's Health Initiative Randomized Trial. Jama. 2003, 289: 3243-3253. 10.1001/jama.289.24.3243.CrossRefPubMed Chlebowski RT, Hendrix SL, Langer RD, Stefanick ML, Gass M, Lane D, Rodabough RJ, Gilligan MA, Cyr MG, Thomson CA, Khandekar J, Petrovitch H, McTiernan A: Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women's Health Initiative Randomized Trial. Jama. 2003, 289: 3243-3253. 10.1001/jama.289.24.3243.CrossRefPubMed
3.
go back to reference Harding C, Knox WF, Faragher EB, Baildam A, Bundred NJ: Hormone replacement therapy and tumour grade in breast cancer: prospective study in screening unit. Bmj. 1996, 312: 1646-1647.CrossRefPubMedPubMedCentral Harding C, Knox WF, Faragher EB, Baildam A, Bundred NJ: Hormone replacement therapy and tumour grade in breast cancer: prospective study in screening unit. Bmj. 1996, 312: 1646-1647.CrossRefPubMedPubMedCentral
4.
go back to reference Magnusson C, Holmberg L, Norden T, Lindgren A, Persson I: Prognostic characteristics in breast cancers after hormone replacement therapy. Breast Cancer Res Treat. 1996, 38: 325-334. 10.1007/BF01806152.CrossRefPubMed Magnusson C, Holmberg L, Norden T, Lindgren A, Persson I: Prognostic characteristics in breast cancers after hormone replacement therapy. Breast Cancer Res Treat. 1996, 38: 325-334. 10.1007/BF01806152.CrossRefPubMed
5.
go back to reference Holli K, Isola J, Cuzick J: Low biologic aggressiveness in breast cancer in women using hormone replacement therapy. J Clin Oncol. 1998, 16: 3115-3120.PubMed Holli K, Isola J, Cuzick J: Low biologic aggressiveness in breast cancer in women using hormone replacement therapy. J Clin Oncol. 1998, 16: 3115-3120.PubMed
6.
go back to reference Fowble B, Hanlon A, Freedman G, Patchefsky A, Kessler H, Nicolaou N, Hoffman J, Sigurdson E, Boraas M, Goldstein L: Postmenopausal hormone replacement therapy: effect on diagnosis and outcome in early-stage invasive breast cancer treated with conservative surgery and radiation. J Clin Oncol. 1999, 17: 1680-1688.PubMed Fowble B, Hanlon A, Freedman G, Patchefsky A, Kessler H, Nicolaou N, Hoffman J, Sigurdson E, Boraas M, Goldstein L: Postmenopausal hormone replacement therapy: effect on diagnosis and outcome in early-stage invasive breast cancer treated with conservative surgery and radiation. J Clin Oncol. 1999, 17: 1680-1688.PubMed
7.
go back to reference Schairer C, Gail M, Byrne C, Rosenberg PS, Sturgeon SR, Brinton LA, Hoover RN: Estrogen replacement therapy and breast cancer survival in a large screening study. J Natl Cancer Inst. 1999, 91: 264-270. 10.1093/jnci/91.3.264.CrossRefPubMed Schairer C, Gail M, Byrne C, Rosenberg PS, Sturgeon SR, Brinton LA, Hoover RN: Estrogen replacement therapy and breast cancer survival in a large screening study. J Natl Cancer Inst. 1999, 91: 264-270. 10.1093/jnci/91.3.264.CrossRefPubMed
8.
go back to reference Stallard S, Litherland JC, Cordiner CM, Dobson HM, George WD, Mallon EA, Hole D: Effect of hormone replacement therapy on the pathological stage of breast cancer: population based, cross sectional study. Bmj. 2000, 320: 348-349. 10.1136/bmj.320.7231.348.CrossRefPubMedPubMedCentral Stallard S, Litherland JC, Cordiner CM, Dobson HM, George WD, Mallon EA, Hole D: Effect of hormone replacement therapy on the pathological stage of breast cancer: population based, cross sectional study. Bmj. 2000, 320: 348-349. 10.1136/bmj.320.7231.348.CrossRefPubMedPubMedCentral
9.
go back to reference Esteve J, Seradour B, Jacquemier J, Remontet L: Does a better grade of tumour occurring in women under hormone replacement therapy compensate for their lower probability of detection by screening mammography. J Med Screen. 2002, 9: 70-73. 10.1136/jms.9.2.70.CrossRefPubMed Esteve J, Seradour B, Jacquemier J, Remontet L: Does a better grade of tumour occurring in women under hormone replacement therapy compensate for their lower probability of detection by screening mammography. J Med Screen. 2002, 9: 70-73. 10.1136/jms.9.2.70.CrossRefPubMed
10.
go back to reference Sacchini V, Zurrida S, Andreoni G, Luini A, Galimberti V, Veronesi P, Intra M, Viale G, Veronesi U: Pathologic and biological prognostic factors of breast cancers in short- and long-term hormone replacement therapy users. Ann Surg Oncol. 2002, 9: 266-271.CrossRefPubMed Sacchini V, Zurrida S, Andreoni G, Luini A, Galimberti V, Veronesi P, Intra M, Viale G, Veronesi U: Pathologic and biological prognostic factors of breast cancers in short- and long-term hormone replacement therapy users. Ann Surg Oncol. 2002, 9: 266-271.CrossRefPubMed
11.
go back to reference Daling JR, Malone KE, Doody DR, Voigt LF, Bernstein L, Marchbanks PA, Coates RJ, Norman SA, Weiss LK, Ursin G, Burkman RT, Deapen D, Folger SG, McDonald JA, Simon MS, Strom BL, Spirtas R: Association of regimens of hormone replacement therapy to prognostic factors among women diagnosed with breast cancer aged 50–64 years. Cancer Epidemiol Biomarkers Prev. 2003, 12: 1175-1181.PubMed Daling JR, Malone KE, Doody DR, Voigt LF, Bernstein L, Marchbanks PA, Coates RJ, Norman SA, Weiss LK, Ursin G, Burkman RT, Deapen D, Folger SG, McDonald JA, Simon MS, Strom BL, Spirtas R: Association of regimens of hormone replacement therapy to prognostic factors among women diagnosed with breast cancer aged 50–64 years. Cancer Epidemiol Biomarkers Prev. 2003, 12: 1175-1181.PubMed
12.
go back to reference Gertig DM, Erbas B, Fletcher A, Amos A, Kavanagh AM: Duration of hormone replacement therapy, breast tumour size and grade in a screening programme. Breast Cancer Res Treat. 2003, 80: 267-273. 10.1023/A:1024953926221.CrossRefPubMed Gertig DM, Erbas B, Fletcher A, Amos A, Kavanagh AM: Duration of hormone replacement therapy, breast tumour size and grade in a screening programme. Breast Cancer Res Treat. 2003, 80: 267-273. 10.1023/A:1024953926221.CrossRefPubMed
13.
go back to reference Kerlikowske K, Miglioretti DL, Ballard-Barbash R, Weaver DL, Buist DS, Barlow WE, Cutter G, Geller BM, Yankaskas B, Taplin SH, Carney PA: Prognostic characteristics of breast cancer among postmenopausal hormone users in a screened population. J Clin Oncol. 2003, 21: 4314-4321. 10.1200/JCO.2003.05.151.CrossRefPubMed Kerlikowske K, Miglioretti DL, Ballard-Barbash R, Weaver DL, Buist DS, Barlow WE, Cutter G, Geller BM, Yankaskas B, Taplin SH, Carney PA: Prognostic characteristics of breast cancer among postmenopausal hormone users in a screened population. J Clin Oncol. 2003, 21: 4314-4321. 10.1200/JCO.2003.05.151.CrossRefPubMed
14.
go back to reference Stahlberg C, Pedersen AT, Andersen ZJ, Keiding N, Hundrup YA, Obel EB, Moller S, Rank F, Ottesen B, Lynge E: Breast cancer with different prognostic characteristics developing in Danish women using hormone replacement therapy. Br J Cancer. 2004, 91: 644-650.PubMedPubMedCentral Stahlberg C, Pedersen AT, Andersen ZJ, Keiding N, Hundrup YA, Obel EB, Moller S, Rank F, Ottesen B, Lynge E: Breast cancer with different prognostic characteristics developing in Danish women using hormone replacement therapy. Br J Cancer. 2004, 91: 644-650.PubMedPubMedCentral
15.
go back to reference Kerlikowske K, Miglioretti DL, Buist DS, Walker R, Carney PA: Declines in invasive breast cancer and use of postmenopausal hormone therapy in a screening mammography population. J Natl Cancer Inst. 2007, 99: 1335-1339. 10.1093/jnci/djm111.CrossRefPubMed Kerlikowske K, Miglioretti DL, Buist DS, Walker R, Carney PA: Declines in invasive breast cancer and use of postmenopausal hormone therapy in a screening mammography population. J Natl Cancer Inst. 2007, 99: 1335-1339. 10.1093/jnci/djm111.CrossRefPubMed
16.
go back to reference Bergkvist L, Adami HO, Persson I, Bergstrom R, Krusemo UB: Prognosis after breast cancer diagnosis in women exposed to estrogen and estrogen–progestogen replacement therapy. Am J Epidemiol. 1989, 130: 221-228.PubMed Bergkvist L, Adami HO, Persson I, Bergstrom R, Krusemo UB: Prognosis after breast cancer diagnosis in women exposed to estrogen and estrogen–progestogen replacement therapy. Am J Epidemiol. 1989, 130: 221-228.PubMed
17.
go back to reference Ewertz M, Gillanders S, Meyer L, Zedeler K: Survival of breast cancer patients in relation to factors which affect the risk of developing breast cancer. Int J Cancer. 1991, 49: 526-530. 10.1002/ijc.2910490409.CrossRefPubMed Ewertz M, Gillanders S, Meyer L, Zedeler K: Survival of breast cancer patients in relation to factors which affect the risk of developing breast cancer. Int J Cancer. 1991, 49: 526-530. 10.1002/ijc.2910490409.CrossRefPubMed
18.
go back to reference Strickland DM, Gambrell RD, Butzin CA, Strickland K: The relationship between breast cancer survival and prior postmenopausal estrogen use. Obstet Gynecol. 1992, 80: 400-404.PubMed Strickland DM, Gambrell RD, Butzin CA, Strickland K: The relationship between breast cancer survival and prior postmenopausal estrogen use. Obstet Gynecol. 1992, 80: 400-404.PubMed
19.
go back to reference Jernstrom H, Frenander J, Ferno M, Olsson H: Hormone replacement therapy before breast cancer diagnosis significantly reduces the overall death rate compared with never-use among 984 breast cancer patients. Br J Cancer. 1999, 80: 1453-1458. 10.1038/sj.bjc.6690543.CrossRefPubMedPubMedCentral Jernstrom H, Frenander J, Ferno M, Olsson H: Hormone replacement therapy before breast cancer diagnosis significantly reduces the overall death rate compared with never-use among 984 breast cancer patients. Br J Cancer. 1999, 80: 1453-1458. 10.1038/sj.bjc.6690543.CrossRefPubMedPubMedCentral
20.
go back to reference Fletcher AS, Erbas B, Kavanagh AM, Hart S, Rodger A, Gertig DM: Use of hormone replacement therapy (HRT) and survival following breast cancer diagnosis. Breast. 2005, 14: 192-200. 10.1016/j.breast.2004.08.018.CrossRefPubMed Fletcher AS, Erbas B, Kavanagh AM, Hart S, Rodger A, Gertig DM: Use of hormone replacement therapy (HRT) and survival following breast cancer diagnosis. Breast. 2005, 14: 192-200. 10.1016/j.breast.2004.08.018.CrossRefPubMed
21.
go back to reference Magnusson C, Baron JA, Correia N, Bergstrom R, Adami HO, Persson I: Breast-cancer risk following long-term oestrogen- and oestrogen–progestin-replacement therapy. Int J Cancer. 1999, 81: 339-344. 10.1002/(SICI)1097-0215(19990505)81:3<339::AID-IJC5>3.0.CO;2-6.CrossRefPubMed Magnusson C, Baron JA, Correia N, Bergstrom R, Adami HO, Persson I: Breast-cancer risk following long-term oestrogen- and oestrogen–progestin-replacement therapy. Int J Cancer. 1999, 81: 339-344. 10.1002/(SICI)1097-0215(19990505)81:3<339::AID-IJC5>3.0.CO;2-6.CrossRefPubMed
22.
go back to reference Nystrom L, Larsson LG, Rutqvist LE, Lindgren A, Lindqvist M, Ryden S, Andersson I, Bjurstam N, Fagerberg G, Frisell J, Tabár L: Determination of cause of death among breast cancer cases in the Swedish randomized mammography screening trials. A comparison between official statistics and validation by an endpoint committee. Acta Oncol. 1995, 34: 145-152. 10.3109/02841869509093948.CrossRefPubMed Nystrom L, Larsson LG, Rutqvist LE, Lindgren A, Lindqvist M, Ryden S, Andersson I, Bjurstam N, Fagerberg G, Frisell J, Tabár L: Determination of cause of death among breast cancer cases in the Swedish randomized mammography screening trials. A comparison between official statistics and validation by an endpoint committee. Acta Oncol. 1995, 34: 145-152. 10.3109/02841869509093948.CrossRefPubMed
23.
go back to reference Elston CW, Ellis IO: Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology. 1991, 19: 403-410. 10.1111/j.1365-2559.1991.tb00229.x.CrossRefPubMed Elston CW, Ellis IO: Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology. 1991, 19: 403-410. 10.1111/j.1365-2559.1991.tb00229.x.CrossRefPubMed
24.
go back to reference Lacroix M, Toillon RA, Leclercq G: Stable 'portrait' of breast tumors during progression: data from biology, pathology and genetics. Endocr Relat Cancer. 2004, 11: 497-522. 10.1677/erc.1.00758.CrossRefPubMed Lacroix M, Toillon RA, Leclercq G: Stable 'portrait' of breast tumors during progression: data from biology, pathology and genetics. Endocr Relat Cancer. 2004, 11: 497-522. 10.1677/erc.1.00758.CrossRefPubMed
25.
go back to reference Simpson PT, Reis-Filho JS, Gale T, Lakhani SR: Molecular evolution of breast cancer. J Pathol. 2005, 205: 248-254. 10.1002/path.1691.CrossRefPubMed Simpson PT, Reis-Filho JS, Gale T, Lakhani SR: Molecular evolution of breast cancer. J Pathol. 2005, 205: 248-254. 10.1002/path.1691.CrossRefPubMed
26.
go back to reference Webster LR, Bilous AM, Willis L, Byth K, Burgemeister FC, Salisbury EL, Clarke CL, Balleine RL: Histopathologic indicators of breast cancer biology: insights from population mammographic screening. Br J Cancer. 2005, 92: 1366-1371. 10.1038/sj.bjc.6602501.CrossRefPubMedPubMedCentral Webster LR, Bilous AM, Willis L, Byth K, Burgemeister FC, Salisbury EL, Clarke CL, Balleine RL: Histopathologic indicators of breast cancer biology: insights from population mammographic screening. Br J Cancer. 2005, 92: 1366-1371. 10.1038/sj.bjc.6602501.CrossRefPubMedPubMedCentral
27.
go back to reference Ross RK, Paganini-Hill A, Wan PC, Pike MC: Effect of hormone replacement therapy on breast cancer risk: estrogen versus estrogen plus progestin. J Natl Cancer Inst. 2000, 92: 328-332. 10.1093/jnci/92.4.328.CrossRefPubMed Ross RK, Paganini-Hill A, Wan PC, Pike MC: Effect of hormone replacement therapy on breast cancer risk: estrogen versus estrogen plus progestin. J Natl Cancer Inst. 2000, 92: 328-332. 10.1093/jnci/92.4.328.CrossRefPubMed
28.
go back to reference Schairer C, Lubin J, Troisi R, Sturgeon S, Brinton L, Hoover R: Menopausal estrogen and estrogen–progestin replacement therapy and breast cancer risk. Jama. 2000, 283: 485-491. 10.1001/jama.283.4.485.CrossRefPubMed Schairer C, Lubin J, Troisi R, Sturgeon S, Brinton L, Hoover R: Menopausal estrogen and estrogen–progestin replacement therapy and breast cancer risk. Jama. 2000, 283: 485-491. 10.1001/jama.283.4.485.CrossRefPubMed
29.
go back to reference Borgquist S, Anagnostaki L, Jirstrom K, Landberg G, Manjer J: Breast tumours following combined hormone replacement therapy express favourable prognostic factors. Int J Cancer. 2007, 120: 2202-2207. 10.1002/ijc.22542.CrossRefPubMed Borgquist S, Anagnostaki L, Jirstrom K, Landberg G, Manjer J: Breast tumours following combined hormone replacement therapy express favourable prognostic factors. Int J Cancer. 2007, 120: 2202-2207. 10.1002/ijc.22542.CrossRefPubMed
30.
go back to reference Stefanick ML, Anderson GL, Margolis KL, Hendrix SL, Rodabough RJ, Paskett ED, Lane DS, Hubbell FA, Assaf AR, Sarto GE, Schenken RS, Yasmeen S, Lessin L, Chlebowski RT: Effects of conjugated equine estrogens on breast cancer and mammography screening in postmenopausal women with hysterectomy. Jama. 2006, 295: 1647-1657. 10.1001/jama.295.14.1647.CrossRefPubMed Stefanick ML, Anderson GL, Margolis KL, Hendrix SL, Rodabough RJ, Paskett ED, Lane DS, Hubbell FA, Assaf AR, Sarto GE, Schenken RS, Yasmeen S, Lessin L, Chlebowski RT: Effects of conjugated equine estrogens on breast cancer and mammography screening in postmenopausal women with hysterectomy. Jama. 2006, 295: 1647-1657. 10.1001/jama.295.14.1647.CrossRefPubMed
31.
go back to reference Bonnier P, Bessenay F, Sasco AJ, Beedassy B, Lejeune C, Romain S, Charpin C, Piana L, Martin PM: Impact of menopausal hormone-replacement therapy on clinical and laboratory characteristics of breast cancer. Int J Cancer. 1998, 79: 278-282. 10.1002/(SICI)1097-0215(199806)79:3<278::AID-IJC12>3.0.CO;2-5.CrossRefPubMed Bonnier P, Bessenay F, Sasco AJ, Beedassy B, Lejeune C, Romain S, Charpin C, Piana L, Martin PM: Impact of menopausal hormone-replacement therapy on clinical and laboratory characteristics of breast cancer. Int J Cancer. 1998, 79: 278-282. 10.1002/(SICI)1097-0215(199806)79:3<278::AID-IJC12>3.0.CO;2-5.CrossRefPubMed
32.
go back to reference Anderson WF, Jatoi I, Devesa SS: Distinct breast cancer incidence and prognostic patterns in the NCI's SEER program: suggesting a possible link between etiology and outcome. Breast Cancer Res Treat. 2005, 90: 127-137. 10.1007/s10549-004-3777-3.CrossRefPubMed Anderson WF, Jatoi I, Devesa SS: Distinct breast cancer incidence and prognostic patterns in the NCI's SEER program: suggesting a possible link between etiology and outcome. Breast Cancer Res Treat. 2005, 90: 127-137. 10.1007/s10549-004-3777-3.CrossRefPubMed
33.
go back to reference Glass AG, Lacey JV, Carreon JD, Hoover RN: Breast cancer incidence, 1980–2006: combined roles of menopausal hormone therapy, screening mammography, and estrogen receptor status. J Natl Cancer Inst. 2007, 99: 1152-1161. 10.1093/jnci/djm059.CrossRefPubMed Glass AG, Lacey JV, Carreon JD, Hoover RN: Breast cancer incidence, 1980–2006: combined roles of menopausal hormone therapy, screening mammography, and estrogen receptor status. J Natl Cancer Inst. 2007, 99: 1152-1161. 10.1093/jnci/djm059.CrossRefPubMed
34.
go back to reference Ravdin PM, Cronin KA, Howlader N, Berg CD, Chlebowski RT, Feuer EJ, Edwards BK, Berry DA: The decrease in breast-cancer incidence in 2003 in the United States. N Engl J Med. 2007, 356: 1670-1674. 10.1056/NEJMsr070105.CrossRefPubMed Ravdin PM, Cronin KA, Howlader N, Berg CD, Chlebowski RT, Feuer EJ, Edwards BK, Berry DA: The decrease in breast-cancer incidence in 2003 in the United States. N Engl J Med. 2007, 356: 1670-1674. 10.1056/NEJMsr070105.CrossRefPubMed
36.
go back to reference Antoine C, Liebens F, Carly B, Pastijn A, Neusy S, Rozenberg S: Safety of hormone therapy after breast cancer: a qualitative systematic review. Hum Reprod. 2007, 22: 616-622. 10.1093/humrep/del393.CrossRefPubMed Antoine C, Liebens F, Carly B, Pastijn A, Neusy S, Rozenberg S: Safety of hormone therapy after breast cancer: a qualitative systematic review. Hum Reprod. 2007, 22: 616-622. 10.1093/humrep/del393.CrossRefPubMed
Metadata
Title
Menopausal hormone therapy in relation to breast cancer characteristics and prognosis: a cohort study
Authors
Lena U Rosenberg
Fredrik Granath
Paul W Dickman
Kristjana Einarsdóttir
Sara Wedrén
Ingemar Persson
Per Hall
Publication date
01-10-2008
Publisher
BioMed Central
Published in
Breast Cancer Research / Issue 5/2008
Electronic ISSN: 1465-542X
DOI
https://doi.org/10.1186/bcr2145

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