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Risk stratification may guide hormone replacement therapy in breast cancer
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The effects of hormone replacement therapy on breast cancer risk among postmenopausal women varied based on race/ethnicity, BMI and breast density, according to study results.
Prior research suggested certain patient factors may influence the association between hormone replacement therapy and breast cancer risk.
In the current analysis, eligible participants included postmenopausal women aged 45 years or older.
Researchers used the Breast Cancer Surveillance Consortium — a registry of mammography screening in the United States — to analyze results of 1.64 million screening mammograms and 9,300 breast cancer cases.
Based on their analysis, researchers observed an association between hormone replacement therapy use and >20% increased risk for breast cancer among white (OR=1.21; 95% CI, 1.14-1.28), Asian (OR=1.58; 95% CI, 1.18-2.11) and Hispanic women (OR=1.35; 95% CI, 1.09-1.67). The association was not observed among black women (OR=0.91; 95% CI, 0.72-1.14).
Researchers observed the highest breast cancer risk among hormone therapy recipients with low or normal BMI and extremely dense breasts (OR=1.49 compared with nonusers; 95% CI, 1.21-1.83).
Hormone replacement therapy was not associated with increased breast cancer risk among overweight or obese women with less dense breasts.
Based on the findings, use of a risk stratification system could help guide clinicians in their use of hormone replacement therapy to relieve patients’ symptoms of menopause.
The study adds to the evidence that suggests only certain cohorts of postmenopausal women may be at increased risk for breast cancer after hormone replacement therapy, Mary Beth Terry, PhD, of the department of epidemiology and the Mailman School of Public Health at Columbia University in New York, and Parisa Tehranifar, DrPH, of the Herbert Irving Comprehensive Cancer Center at Columbia University, wrote in an accompanying editorial.
The study is the largest of its kind to investigate all three potential risk factors, they wrote.
“Even this large study, though, is underpowered for examining race/ethnicity interactions with both BMI and breast density,” they wrote. “Hou and colleagues challenge us to consider whether hormone replacement therapy use may have minimal to no impact on breast cancer risk in certain subgroups. Properly weighing the risks and benefits of hormone replacement therapy requires an understanding of the absolute differences, in addition to the relative.”
Improved risk stratification may ultimately improve the use of all chemopreventive drugs, not just hormone therapy, Terry and Tehranifar wrote.
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Disclosure: The researchers report support from the American Cancer Society. Tehranifar reports support from NCI Grant K07 CA151777.