Impact of menopausal hormone-replacement therapy on clinical and laboratory characteristics of breast cancer

Abstract

Hormone‐replacement therapy (HRT) is widely used by post‐menopausal women. Although this treatment may slightly increase the incidence of breast cancer, more and more cases are diagnosed while women are taking HRT. The purpose of this study was to ascertain the influence of HRT on prognostic factors and outcome of breast cancer. Data on all breast‐cancer patients, including precise information on HRT, was prospectively and systematically recorded in a data base. From 1985 to 1995, 1379 post‐menopausal women fulfilled the eligibility criteria for this study. All were treated by us (P.B. and L.P.) in our ward of a large public hospital of Marseilles, France. The clinical features, laboratory findings and survival rates in 142 HRT users who developed breast cancer while being treated were compared with those of 284 matched never user breast‐cancer patients. Patients who developed breast cancer during HRT had fewer locally advanced cancers and smaller and better‐differentiated cancers. Lymph‐node involvement was significantly less frequent in the user group than in the non‐user group (non‐significant). Estradiol receptivity was both qualitatively and quantitatively lower in users. There was no significant difference with regard to recurrence and metastasis‐free survival and overall survival. We conclude that HRT does not affect the prognosis of breast cancer. Regular surveillance during HRT allows early detection of smaller lesions. The higher number of well‐differentiated cancers and the distribution of hormone receptivity may reflect interaction between neoplastic tissue and exogenous hormones. Int. J. Cancer (Pred. Oncol.) 79:278–282, 1998.© 1998 Wiley‐Liss, Inc.

Assessing the effectiveness of a mammography screening service

“…17,19,24 Some studies have speculated that this may be a result of surveillance bias where patients receiving hormone replacement therapy might be required to obtain annual screening mammograms as a prerequisite to continuing their treatment. 19,[25][26][27] If true, this translates into a better chance of survival for BSWA-detected patients because breast cancer patients who have received hormone replacement therapy have been documented to have better prognosis. 19,24,26,28,29 Tabar et al 7 used data from the Swedish Two County Study to identify surrogate end-points along the path to effective reduction in mortality from breast cancer, and these have since been accepted by numerous researchers as targets for a successful mammography programme.…”

Menopausal Hormone Therapy and Risk of Clinical Breast Cancer Subtypes

“…Hormone therapy has been found to confer greater risk on invasive lobular, tubular, and mixed ductal-lobular histologic types (5-7)-types associated with better outcomes in some but not all studies-than for invasive ductal cancers. In addition, hormone therapy -associated tumors have been shown to be smaller (8)(9)(10)(11), hormone receptor positive (12)(13)(14), of lower grade (14)(15)(16)(17)(18), and to have fewer affected nodes (9,19) than tumors not associated with hormone therapy use. However, due to the strong correlation between histologic type and clinical characteristics, in particular estrogen receptor/ progesterone receptor (ER/PR) status (20)(21)(22)(23)(24), it is unclear which tumor subtypes are most strongly associated with hormone therapy use.…”

The Impact of Hormone Replacement Therapy on the Detection and Stage of Breast Cancer

“…First, some authors advocate the theory that HRT users undergo more frequent screening. 14,[16][17][18] Second, others state that patients with breast cancer who have received HRT prior to diagnosis develop tumors that behave less aggressively. 4,14 The aim of our retrospective review of patients with breast cancer who were postmenopausal was 3-fold: to investigate the relationship between HRT and mammographic detection, to examine the theory that breast tumors in HRT users are biologically less aggressive, and to explore the mechanisms by which a history of HRT use improves survival in women diagnosed as having breast cancer.…”