Breast cancer after hormone replacement therapy – does prognosis differ in perimenopausal and postmenopausal women?

Abstract

Hormone replacement therapy (HRT) has been associated with higher incidence of breast cancer in postmenopausal women, but it is unclear if breast cancers developing after HRT use have different prognosis. 1053 women with hormone receptor positive non-metastasized breast cancer were analyzed in a retrospective trial, stratifying by HRT use before diagnosis. Postmenopausal HRT users had significantly more early tumor stages (p<0.001). HRT in postmenopausal patients was associated with longer time to progression (TTP) (HR 0.81, 95%CI 0.55-1.19, p=0.28) and overall survival (OS) (HR 0.68, 95%CI 0.45-1.02, p=0.059). Perimenopausal HRT users showed shorter TTP and OS (HR 1.99, 95%CI 0.57-6.91, p=0.28 and HR 4.59, 95%CI 0.91-23.25, p=0.06 respectively). Higher BMI was significantly associated with poorer prognosis in perimenopausal women only (TTP: HR=1.16; OS: HR=1.31). In this retrospective analysis postmenopausal HRT users seemed to have a better breast cancer prognosis. For perimenopausal HRT users however, a trend towards worse prognosis was found.

Body mass index and survival in women with breast cancer—systematic literature review and meta-analysis of 82 follow-up studies

“…Studies with larger number of deaths [105, 115], conducted in Europe [28, 115], or with weight and height assessed through medical records [28, 104, 115, 116] tended to report weaker associations for BMI <12 months after diagnosis and total mortality compared with other studies (meta-regression P = 0.01, 0.02, 0.01, respectively) (supplementary Table S3, available at Annals of Oncology online); while studies with larger number of deaths [101], conducted in Asia [101, 102], or adjusted for co-morbidity [101, 102] reported weaker associations for BMI <12 months after diagnosis and breast cancer mortality (meta-regression P = 0.01, 0.02, 0.01, respectively) (supplementary Table S4, available at Annals of Oncology online). …”

“…When the extreme BMI categories were open-ended, we used the width of the adjacent close-ended category to estimate the midpoints. Where the RRs were presented by subgroups (age group [27], menopausal status [28, 29], stage [30] or subtype [31] of breast cancer, or others [32–34]), an overall estimate for the study was obtained by a fixed-effect model before pooling in the meta-analysis. We estimated the risk increase of death for an increment of 5 kg/m 2 of BMI.…”

Postdiagnosis body fatness, weight change and breast cancer prognosis: Global Cancer Update Program (CUP global) systematic literature review and meta‐analysis

“…The respective linear dose‐response meta‐analyses included 64 studies that reported all‐cause mortality (52 publications, 32 507 deaths), 39‐41,43‐46,53‐55,57,63‐68,70,72,78,79,81,82,84,85,88,89,91,93‐95,97,98,100,102,104,105,109,111‐114,116,118,120,123,125‐127,129,130,135 39 studies that reported breast cancer‐specific mortality (31 publications, 14 106 deaths), 57,63‐65,74,75,77‐79,82,86,91,93,95,96,98‐103,106,109,110,117,118,122,125,126,128,137 63 studies that reported breast cancer recurrence (49 publications, 29 749 events), 40,41,43‐46,48,51,54‐56,59,63‐66,68‐70,72‐74,76,79,83‐85,88,89,92,94,96,102,104, 106,110,112,115,116,120‐125,127,130,131,136 11 studies that reported second primary breast cancer (eight publications, 5248 events), 58,63,64,87,90,108,132,138 10 studies that reported nonbreast cancer‐related mortality (seven publications, 2307 deaths), 57,63‐65,77,95,106 and two studies that reported cardiovascular mortality (two publications, 124 deaths) 100,114 …”

“…The 220 included publications comprised 226 studies and included over 456 000 women diagnosed with breast cancer, of whom over 36 000 died of any causes, approximately 21 000 died of breast cancer and approximately 30 000 experienced an additional breast cancer event. Geographically, 79 publications were from North America, 27,39,41,46,47,49‐51,53,54,56‐58,61‐64,69,71‐74,77,79‐81,84,87,88,91,93,95,98‐100,107,109,111,113‐115,117,118,124,126‐128,132,140,146,147,149,150,154,165,166,168,170,171,174,175,177‐179,183,184,190,192,200,201,203,211,217,225,235,248,253,256,257 64 from Europe, 43,48,60,66,67,70,76,89,90,92,94,101,103‐105,108,116,130,133,135‐137,141‐145,148,155‐162,164,173,181,182,186,187,191,193‐195,198,199,204,207,208,212,218,219,224,229,230,232,237,240,243,245,246,255 50 from East or Southeast Asia…”

Endokrinologie. Klimawandel - Wenn Frauen in die Wechseljahre kommen

“…Hinweise darauf liefern erste differenzierte Publikationen, die die Prognose einer Brustkrebserkrankung nach Hormontherapie für perimenopausale und postmenopausale Frauen getrennt betrachteten [16]. Die Ergebnisse zeigen: Perimenopausal erkrankte Frauen nach Hormontherapie hatten eher einen Nachteil.…”