Hormone therapy use before diagnosis and breast cancer survival in the California teachers study.

Abstract

#65 Background: Breast cancer survival appears to be improved by pre-diagnostic use of hormone therapy (HT), but it is unclear from existing studies whether this is attributable to a direct beneficial effect of HT or because HT use encourages the development of certain tumor types with better prognosis. It is therefore important to examine whether the association between HT use and survival still remains after adequate adjustment for tumor characteristics.
 Methods: The California Teachers Study is an ongoing prospective study of female public school teachers and administrators. These analyses included 2,783 postmenopausal women whose use of HT was known and who were diagnosed with an incident primary invasive breast cancer after joining the cohort in 1995-96 and followed until death or the end of 2005. Incident cancers and tumor characteristics were ascertained through annual linkage with the statewide California Cancer Registry. Deaths were ascertained through annual linkage with the California state mortality files, the Social Security Administration Death Master File and the National Death Index. HT and other covariates were self-reported on the baseline questionnaire. We estimated the relative risk (RR) of breast cancer death stratifying by age in years, and using age in days from breast cancer diagnosis as the time scale (censoring deaths from other causes).
 Results: During the follow-up period, 159 (5.7%) women died of breast cancer. In unadjusted analysis, former and current HT use, specifically current estrogen-progestin (EP) use (RR=0.37; 0.24-0.57) but also current unopposed estrogen (E) use (RR=0.64; 0.43-0.95), was significantly associated with reduced breast cancer mortality, compared with no HT use. In multivariable analysis, taking into account race, body mass index, smoking history, lifetime physical activity, and co-morbidities, the risk estimates were somewhat attenuated (EP RR=0.40; 0.26-0.63 and E RR=0.67; 0.44-1.00). After additional adjustment for tumor characteristics (stage at diagnosis, estrogen receptor status, number of positive lymph nodes, grade and tumor size) and treatment received (surgery type and radiation) the risk estimates were considerably attenuated (EP RR=0.53; 0.33-0.84 and E RR=0.82; 0.53-1.27).
 Conclusion: Use of EP before diagnosis was associated with a reduced risk of death due to breast cancer. Use of E was also associated with reduced breast cancer mortality, although the association was not statistically significant after adjustment for indicators of general health, characteristics of the tumor and treatment. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 65.

Hormone Therapy and its Effect on the Prognosis in Breast Cancer Patients

“…The grey vertical lines indicate the 20th, 50th, and 80th percentile of age. Several previous studies have demonstrated an effect of previous HT use on overall or BC-specific survival [24,28,29,33,42,43], although others did not observe this effect [44]. Some studies also studied the effect of HT on prognosis in ovarian cancer patients [5].…”

“…One study investigated distant disease-free survival (DMFS) as a measure of the diseaseʼs metastatic activity and reported a favorable effect of previous HT intake on DMFS [32]. It has been hypothesized that this effect on the OS might be related to a selection bias, as HT users may have better general health [33], are better informed about and more aware of health issues, and have a healthier lifestyle and better access to healthcare providers. Better surveillance and earlier detection of tumors at an earlier stage has been suggested as another reason for better OS rates.…”

Hormone replacement therapy and prognosis in ovarian cancer patients

“…For breast cancer, it has been hypothesized that women who receive HRT generally have a better health status (Marshall et al, 2009). Although the direction of the influence on overall survival and progression-free survival is the same in the study (i.e.…”

“…In patients with breast cancer, it is known that the use of estrogen and combined estrogen/progesterone as HRT before the breast cancer is diagnosed reduces the mortality by about 36 and 63%, respectively (Schuetz et al, 2007;Marshall et al, 2009). It was concluded that HRT before diagnosis leads to a more favorable primary tumor, with a lower incidence of recurrence and a better overall survival rate.…”

Kongressbericht vom 31. Annual San Antonio Breast Cancer Symposium von 10.–14.12.2008

“…Ebenfalls interessant war, dass das Gesamtüberleben von Frauen mit Hormoneinnahme und nachfolgendem Brustkrebs sich nicht von dem der Frauen mit Placebo und nachfolgendem Mammakarzinom unterscheidet. Ein weiterer Vortrag beschäftigte sich mit dem direkten Einfluss von postmenopausaler Hormontherapie auf das spätere Überleben nach Brustkrebs [2]. Als Patientenkollektiv diente eine Kohorte von 2783 Frauen aus dem California-Teacher-Studienkollektiv (insgesamt 133 479 Frauen), bei denen während der Studie ein Mammakarzinom diagnostiziert wurde.…”