Menopausal hormone therapy in relation to breast cancer characteristics and prognosis: a cohort study.
BACKGROUND
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 > 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.
Rosenberg
Lena U
LU
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. lena.u.rosenberg@ki.se
Granath
Fredrik
F
Dickman
Paul W
PW
Einarsdóttir
Kristjana
K
Wedrén
Sara
S
Persson
Ingemar
I
Hall
Per
P
D000368:Aged; D001943:Breast Neoplasms / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy; D002277:Carcinoma / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy; D015331:Cohort Studies; D015914:Estrogen Replacement Therapy / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D020249:Hormone Replacement Therapy / Q000009:adverse effects / Q000706:statistics & numerical data*; D006801:Humans; D008207:Lymphatic Metastasis; D008327:Mammography / Q000706:statistics & numerical data; D008593:Menopause; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology; D047368:Tumor Burden