title: Breast cancer risk during hormone therapy: experimental versus clinical data.
abstract: Evidence is increasing suggesting that adding progestogens to estrogens can increase the risk of breast cancer. However, our experimental data as a result of scientific collaboration between university of Tuebingen, Germany, and university of Beijing, China, comparing all available progestogens used in hormone therapy and hormonal contraception present high evidence that there may be differences regarding breast cancer risk. Especially of concern may be to differentiate between primary and secondary risk i.e. between the effect of on benign and malignant breast epithelial cells suggesting differences in primary risk and risk in patients after breast cancer. Of importance also is that in contrast to natural progesterone the apocrine impact of stromal growth factors and also certain cell components of breast epithelial cells can strongly increase proliferation rates of some (but not all. synthetic progestogens which can lead to clinical cancer before (in contrast to estrogen-only therapy. carcinoprotective mechanisms can work. Regarding clinical data, epidemiological studies and especially the Women's Health Initiative, so far the only prospective placebo-controlled study, demonstrate an increased risk under combined estrogen/progestogen-, but not under estrogen-only therapy. However, up to now the clinical studies cannot discriminate between the various progestogens mostly due to too small patient numbers in the subgroups, and in most studies either medroxyprogesterone acetate or norethisterone have been used. However, there is evidence that the natural progesterone and dydrogesterone, possibly also the transdermal usage of synthetic progestogens, may have less risks, but this must be proven in further clinical trials.
authors.affiliation: Department of Gynecological Endocrinology, University of Beijing, Beijing, China.
authors.forename: X
authors.initials: X
authors.lastname: Ruan
authors.forename: H
authors.initials: H
authors.lastname: Seeger
authors.forename: A O
authors.initials: AO
authors.lastname: Mueck
mesh_terms: D001943:Breast Neoplasms / Q000139:chemically induced* / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control; D002478:Cells, Cultured / Q000187:drug effects; D003043:Cocarcinogenesis; D015331:Cohort Studies; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects; D004311:Double-Blind Method; D004357:Drug Synergism; D004847:Epithelial Cells / Q000187:drug effects; D015914:Estrogen Replacement Therapy / Q000009:adverse effects; D004967:Estrogens / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005260:Female; D020249:Hormone Replacement Therapy / Q000009:adverse effects; D006801:Humans; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D009364:Neoplasm Recurrence, Local / Q000139:chemically induced; D016609:Neoplasms, Second Primary / Q000139:chemically induced; D017698:Postmenopause; D011372:Progestins / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012306:Risk; D014407:Tumor Cells, Cultured / Q000187:drug effects
chemical_list: D003278:Contraceptives, Oral, Hormonal; D004967:Estrogens; D011372:Progestins