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Threefold breast cancer risk linked with hormone therapy
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Patients currently using combined estrogen and progestin hormone therapy for three or more years were found to be at an increased risk for lobular breast cancers.
In a population-based, case-control study conducted by researchers at the University of Washington in Seattle, the association between the risk for breast carcinoma and combined HT was examined in 324 lobular, 196 ductal-lobular and 524 ductal cancer cases and 469 controls aged 55 to 74 years.
After reviewing tissue samples and performing polytomous logistic regression, the researchers found a 2.7-fold elevated risk and 3.3-fold elevated risk for lobular and ductal-lobular cancers, respectively, in current HT users — despite tumor stage, size or nodal status.
Combined HT increased the risk for tumors >50% lobular in ductal-lobular cases.
Additional analyses regarding the etiology of lobular cancers are necessary, the researchers wrote. – by Stacey L. Adams
Cancer Epidemiol Biomarkers Prev. 2008;17:43-50.
The results are consistent with the most important unanswered question: Do the epidemiologic results indicate an effect of HT on pre-existing tumors? A very rapid increase in risk with only a few years of current use of HT, coupled with less aggressive tumors and better survival rates in hormone users, are strong arguments that HT does not cause breast cancer but influences cancers that are already present.
– Leon Speroff, MD
Professor of Obstetrics and Gynecology
Oregon Health & Science University, Portland
I think what the researchers are trying to do is help understand the association between estrogen and progestin in breast cancer; they are trying to understand risk, which is tough to do because there are a lot of things that can influence that. For a clinician, this information is not going to change too much, but for helping us understand what is going on, I think it is a piece of the puzzle. Because breasts are more dense as a result of HT, we need to be more vigilant and inform patients that they are at an increased risk for breast cancer; although, that is not the same as saying we are sure that hormones cause it. When the words “hormone preparation” are used, it is important to understand which one is being used and what the real risks are. We are improving our understanding of what dose is needed for what reasons, which is the best route to take; it is all evolving, and that is good. It is an additional piece of the puzzle.
– Robert A. Wild, MD, PhD, MPH
Professor of Reproductive Endocrinology
Oklahoma University Health Sciences Center, Oklahoma City