A cohort study of hormone replacement therapy given to women previously treated for breast cancer.
Women who have been previously treated for breast cancer are usually advised to avoid hormone therapy for fear of increasing their risk of tumor recurrence. However, for some women, menopausal symptoms are so severe that their quality of life is poor. Because ethic committees are reticent to permit a double-blind randomized trial, we performed a cohort study of hormone therapy after breast cancer.


METHODS
The study group comprised 1472 women with breast cancer. A total of 167 subjects had used an oral or transdermal estrogen after their treatment for breast cancer. Amongst these estrogen users, 152 (91%) had also used a progestin. In total, 106 other women had used a progestin alone as a treatment for menopausal flushes and not as a treatment for breast cancer. Cox regression analysis was performed using estrogen as a time-dependent covariate with disease-free interval as the outcome.


RESULTS
The uncorrected hazard ratio for the estrogen-progestin users was 0.67 (95% confidence interval (CI) 0.38-1.16) and for the progestin alone users was 0.85 (95% CI 0.44-1.65).


CONCLUSIONS
This study was unable to demonstrate a significant increase in risk of breast cancer recurrence for women who used HRT and suggests that the time is now appropriate for a randomized prospective trial of hormone therapy after breast cancer.
Dew
J
J
Women's Health Institute, Royal Hospital for Women, Barker Street, Randwick, NSW 2031, Australia.
Eden
J
J
Beller
E
E
Magarey
C
C
Schwartz
P
P
Crea
P
P
Wren
B
B
D001943:Breast Neoplasms / Q000401:mortality / Q000628:therapy; D015331:Cohort Studies; D018572:Disease-Free Survival; D004965:Estrogen Antagonists / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy / Q000009:adverse effects*; D005260:Female; D019584:Hot Flashes / Q000188:drug therapy; D006801:Humans; D008593:Menopause; D009364:Neoplasm Recurrence, Local; D011372:Progestins / Q000008:administration & dosage; D012044:Regression Analysis; D012307:Risk Factors; D013629:Tamoxifen / Q000627:therapeutic use
D004965:Estrogen Antagonists; D011372:Progestins; D013629:Tamoxifen