A prospective study on women with a history of breast cancer and with or without estrogen replacement therapy

Safety of hormone therapy after breast cancer: a qualitative systematic review

“…Among the four unadjusted studies, Natrajan and Gambrell (2002) do not mention whether the two populations were comparable; Beckmann et al (2001) and Vassilopoulou-Sellin et al (2002) report no difference in prognostic characteristics between the studied populations and controls. Marttunen et al (2001) report an increased rate of node invasion among the controls compared with women exposed to HT.…”

“…A total of 40 articles were found (Stoll, 1989;Wile et al, 1991;DiSaia et al, 1993;Marchant, 1993;Powles et al, 1993;Wile et al, 1993;Vassilopoulou-Sellin and Theriault, 1994;DiSaia et al, 1995;Eden et al, 1995;DiSaia et al, 1996;Peters and Jones, 1996;Decker et al, 1997;Vassilopoulou-Sellin et al, 1997;Bluming et al, 1998;Dew et al, 1998;Gorins et al, 1998;Bluming et al, 1999;Brewster et al, 1999;Espie et al, 1999;Guidozzi, 1999;Natrajan et al, 1999;Ursic-Vrscaj and Bebar, 1999;Vassilopoulou-Sellin et al, 1999;Decker et al, 2000;DiSaia et al, 2000;Marsden et al, 2000;Beckmann et al, 2001;Col et al, 2001;Marttunen et al, 2001;O'Meara et al, 2001;Peters et al, 2001;Durna et al, 2002;Meurer and Lena, 2002;Natrajan and Gambrell, 2002;Vassilopoulou-Sellin et al, 2002;Decker et al, 2003;Dew et al, 2003;Gorins et al, 2003;Holmberg and Anderson, 2004;von Schoultz et al, 2005). Some articles were excluded because they only provided incomplete data or an extremely short follow-up (Stoll, 1...…”

“…In such cases, we selected the article with the highest number of patients or the article that provided the most information. Finally, we selected 20 studies for which we evaluated the design of the study, the methodology, the characteristics of the studied populations, potential sources of bias (detection bias, selection bias, absence of control for some confounding factors) and the consequences of treatment on the disease evolution (Powles et al, 1993;Wile et al, 1993;DiSaia et al, 1996;Vassilopoulou-Sellin et al, 1997;Bluming et al, 1999;Brewster et al, 1999;Guidozzi, 1999;Ursic-Vrscaj and Bebar, 1999;DiSaia et al, 2000;Beckmann et al, 2001;Marttunen et al, 2001;O'Meara et al, 2001;Peters et al, 2001;Durna et al, 2002;Natrajan and Gambrell, 2002;Vassilopoulou-Sellin et al, 2002;Decker et al, 2003;Gorins et al, 2003;Holmberg and Anderson, 2004;von Schoultz et al, 2005). One study was classified as a prospective controlled study although a small number of the patients had been randomized, and one study was considered to be retrospective even though this information was not specified (Natrajan and Gambrell, 2002;Vassilopoulou-Sellin et al, 2002).…”

“…In only six studies women exposed to HT were matched to controls for certain factors [age, date and stage of disease at diagnosis, tumour size, node involvement, type of surgery, length of follow-up, use of adjuvant treatment, and delay between diagnosis and the beginning of HT (DiSaia et al, 1996;Ursic-Vrscaj and Bebar, 1999;DiSaia et al, 2000;O'Meara et al, 2001;Decker et al, 2003;Gorins et al, 2003)]. In four controlled studies, women exposed to HT were not matched to controls (Marttunen et al, 2001;Durna et al, 2002;Natrajan and Gambrell, 2002;Vassilopoulou-Sellin et al, 2002), but in the study of Durna et al (2002), results were adjusted based on tumour size, age at the time of diagnosis and year of diagnosis. Among the four unadjusted studies, Natrajan and Gambrell (2002) do not mention whether the two populations were comparable; Beckmann et al (2001) and Vassilopoulou-Sellin et al (2002) report no difference in prognostic characteristics between the studied populations and controls.…”

“…On the contrary, HT is seldom prescribed for fear of increased risk of recurrence even though, in the last decade, the question has been raised whether HT is really contra-indicated in these patients (Cobleigh et al, 1994;Brzezinski, 1995). Various observations led to this hypothesis: (i) Women who have had BC and have decided to become pregnant do not appear to increase their risk of recurrence, although pregnancy is associated with a high estrogen climate; young pregnant women who are affected by BC have a similar prognosis as their agerelated peers, and an abortion during pregnancy does not better their prognosis (Gorins et al, 1998); (ii) Some studies reported that mortality due to BC is similar or even lower in HT users or contraceptive-pill users than in non-users (Holli et al, 1998;Batur et al, 2006); (iii) Several small observational trials reported no increase in BC recurrences in patients using HT (DiSaia et al, 1996;Ursic-Vrscaj and Bebar, 1999;DiSaia et al, 2000;Marttunen et al, 2001;O'Meara et al, 2001;Durna et al, 2002;Natrajan and Gambrell, 2002;Vassilopoulou-Sellin et al, 2002;Decker et al, 2003). Nevertheless, the last two points have become controversial since the publication of the results of the Women's Health Initiative (WHI) study (Chlebowski et al, 2003) and the reports of the HABITS trial (Holmberg and Anderson, 2004).…”