A Meta-analysis of the Effect of Estrogen Replacement Therapy on the Risk of Breast Cancer

Karen K. Steinberg, PhD, MSc; Stephen B. Thacker, MD, MSc; S. Jay Smith, MS, MIS; Donna F. Stroup, PhD, MSc; Matthew M. Zack, MD; W. Dana Flanders, MD, DSc; Ruth L. Berkelman, MD
JAMA. 1991;265(15):1985-1990. doi:10.1001/jama.1991.03460150089030.
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To quantify the effect of estrogen replacement therapy on breast cancer risk, we combined dose-response slopes of the relative risk of breast cancer against the duration of estrogen use across 16 studies. Using this summary dose-response slope, we calculated the proportional increase in risk of breast cancer for each year of estrogen use. For women who experienced any type of menopause, risk did not appear to increase until after at least 5 years of estrogen use. After 15 years of estrogen use, we found a 30% increase in the risk of breast cancer (relative risk, 1.3; 95% confidence interval [CI], 1.2 to 1.6). The increase in risk was largely due to results of studies that included premenopausal women or women using estradiol (with or without progestin), studies for which the estimated relative risk was 2.2 (CI, 1.4 to 3.4) after 15 years. Among women with a family history of breast cancer, those who had ever used estrogen replacement had a significantly higher risk (3.4; CI, 2.0 to 6.0) than those who had not (1.5; CI, 1.2 to 1.7).

(JAMA. 1991;265:1985-1990)


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