Influence of HRT on prognostic factors for breast cancer: a systematic review after the Women's Health Initiative trial

Antoine, Caroline

doi:10.1093/humrep/deh112

Cited by 41 publications

(25 citation statements)

References 49 publications

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“…The study was underpowered to access the effect on grade, histology and hormone receptor status. A recent systematic review of 25 studies that evaluated breast cancer risk factors and prognostic indicators concluded that the WHI study is in contradiction to most published observational studies (Antonie et al, 2004). Our results also appear to contradict the WHI results.…”

Section: Discussioncontrasting

confidence: 94%

Mortality following development of breast cancer while using oestrogen or oestrogen plus progestin: a computer record-linkage study

2005

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The literature on the relationship between breast cancer mortality and postmenopausal oestrogen and combined oestrogen/ progestin therapy is seemingly contradictory. This study explored survival after exposure to oestrogen or oestrogen plus progestin at or in the year prior to breast cancer diagnosis. Information on patients first diagnosed with invasive breast cancer between 1993 and 1998 was linked with outpatient pharmacy data from 1992 to 2000. Patients were classified according to use of oestrogen alone or oestrogen plus progestin at or in the year prior to diagnosis. Compared to nonusers, and adjusting for age at diagnosis, race/ethnicity, tumour size and grade, oestrogen receptor status, surgery status, and chemotherapy and hormone therapy for breast cancer treatment, oestrogen plus progestin users had lower all-cause mortality (stage I hazard ratio ( Our findings suggest, relative to nonusers, a lower risk of death from all causes and from breast cancer in patients who were diagnosed with breast cancer while exposed to oestrogen plus progestin, but not in patients exposed to oestrogen only.

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Section: Discussioncontrasting

confidence: 94%

Mortality following development of breast cancer while using oestrogen or oestrogen plus progestin: a computer record-linkage study

2005

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“…Most observational studies indicate such an association, whereas the Women's Health Study randomized trial found HRT oestrogen -progestin use to be associated with larger and lymph node-positive tumours (Antoine et al, 2004). If HRT is linked to less aggressive tumours, our finding of a poorer survival among obese women only among HRT users could be explained as follows: the beneficial prognostic effect seen by HRT in most observational studies is confined to lean women, in whom the HRT effect is most pronounced.…”

Section: Discussionmentioning

confidence: 99%

Obesity and poor breast cancer prognosis: an illusion because of hormone replacement therapy?

2009

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High body mass index (BMI) and use of hormone replacement therapy (HRT) increase the risk of postmenopausal breast cancer. It has been shown that BMI modifies the effect of HRT, as its influence is most pronounced in lean women. We investigated the influence of BMI and HRT on prognosis in 2640 postmenopausal women diagnosed with breast cancer in Sweden in 1993 -1995, taking into account HRT and mammography before diagnosis. Logistic and Cox regression were used. In non-users of HRT, obese women (BMI 430) compared with normal weight women (BMI o25) had a similar prognosis (hazard ratio (HR) 1.1, 95% confidence interval (CI) 0.8 -1.6), despite larger tumours found in obese women. Obese HRT users had less favourable tumour characteristics and poorer prognosis compared with normal weight women (HR 3.7, 95% CI 1.9 -7.2). The influence of BMI on breast cancer prognosis was similar whether diagnosed by mammographic screening or not. We found a similar prognosis of postmenopausal breast cancer-specific death regardless of BMI in non-users of HRT, but among HRT users obesity was associated with a poorer breast cancer prognosis.

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“…Recently, Rosenberg (2006) analyzed breast cancer prognosis data obtained from the Swedish death registry, for cases in this study, for association with HRT use. In line with the observational studies reviewed by Antoine et al (2004), Rosenberg (2006) reported a positive association between HRT use and favorable prognostic factors. In particular, associations were found between tumor size and grade.…”

Section: Applicationmentioning

confidence: 53%

“…There is also clear evidence of a dosage effect of HRT on risk (See Figure 3 in Million Women Study Collaborators (2003)). Many recent studies have investigated the relationship between HRT use and prognosis in breast cancer patients; see Antoine et al (2004) for an overview. Most of these studies reported HRT to be associated with a favorable prognosis.…”

Section: Introductionmentioning

confidence: 99%

A Principal Stratification Approach to Assess the Differences in Prognosis between Cancers Caused by Hormone Replacement Therapy and by Other Factors

Sjölander

Vansteelandt²,

Humphreys³

2010

The International Journal of Biostatistics

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Several recent studies have reported that women who have used hormone replacement therapy (HRT), and developed breast cancer, tend to have a better prognosis than women with breast cancer who have not used HRT. One possible explanation is that tumors caused by HRT are more benign than tumors caused by other factors. Although it is relevant to quantify differences in prognostic factors across subtypes of breast cancer, it is not obvious how to do this correctly. This is because the tumors which occur among women who are treated with HRT are a mixture of HRT-induced and other tumors. We propose a framework based on principal stratification to distinguish women with HRT-induced tumors from women with tumors caused by other factors. To estimate the difference in prognosis for these two groups, we propose two estimation methods, which can be used under both cohort and case-control sampling schemes.

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Influence of HRT on prognostic factors for breast cancer: a systematic review after the Women's Health Initiative trial

Abstract: In view of these data, the current clinical message to patients should be changed: one can no longer declare that breast cancers developed while using HRT are of better prognosis.

Cited by 41 publications

References 49 publications

Mortality following development of breast cancer while using oestrogen or oestrogen plus progestin: a computer record-linkage study

Mortality following development of breast cancer while using oestrogen or oestrogen plus progestin: a computer record-linkage study

Obesity and poor breast cancer prognosis: an illusion because of hormone replacement therapy?

A Principal Stratification Approach to Assess the Differences in Prognosis between Cancers Caused by Hormone Replacement Therapy and by Other Factors

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