Hormone Replacement and Breast Cancer: Title and subTitle BreakA Remaining Controversy? FREE

Hans-Olov Adami, MD, PhD; Ingemar Persson, MD, PhD

[+] Author Affiliations

Reprint requests to Department of Cancer Epidemiology, University Hospital, 5-751 85 Uppsala, Sweden (Dr Persson).

JAMA. 1995;274(2):178-179. doi:10.1001/jama.1995.03530020096039

Text Size: A A A

Published online

Article

References

ABSTRACT

ABSTRACT | REFERENCES

Ever since replacement hormones were introduced some 30 years ago, there has been concern regarding a possible adverse effect on breast cancer risk. More than 30 epidemiological studies have explored the relationship between exogenous hormones and breast cancer. Most of them were of case-control design,^1-3 while seven were prospective cohort studies.^4-10 Despite several attempts to summarize available evidence in overviews¹ and through meta-analyses,^2,3 there is still considerable uncertainty as to whether replacement hormones increase breast cancer risk. However, some recent studies indicate that long-term intake of conjugated estrogens or estradiol compounds is associated with a moderate risk increase.^6,8,11-13 The remaining controversy might be viewed as a shortcoming of the epidemiological method, ie, inability to clarify the role of a potential cause of breast cancer. According to a rival and more optimistic interpretation, the absence of unequivocal evidence for a risk-increasing effect of replacement hormones indicates

REFERENCES

ABSTRACT | REFERENCES

Brinton LA, Schairer C. Estrogen replacement therapy and breast cancer risk. Epidemiol Rev . 1993;;15:66-79.

Dupont WD, Page DL. Menopausal estrogen replacement therapy and breast cancer. Arch Intern Med . 1991;;151:67-72.

Steinberg KK, Thacker SB, Smith JS, et al. A meta-analysis of the effect of estrogen replacement therapy on the risk of breast cancer. JAMA . 1991;;265:1985-1990.

Hoover R, Gray LA Sr, Cole P, et al. Menopausal estrogens and breast cancer. N Engl J Med . 1976;;295:401-405.

Hunt K, Vessey M, McPherson K, et al. Long-term surveillance of mortality and cancer incidence in women receiving hormone replacement therapy. Br J Obstet Gynaecol . 1987;;94:620-635.

Bergkvist L, Adami H-O, persson I, Hoover R, Schairer C. The risk of breast cancer after estrogen and estrogen-progestin replacement. N Engl J Med . 1989;;321: 293-297.

Mills PK, Beeson L, Phillips RL, et al. Prospective study of exogenous hormone use and breast cancer in Seventh-day Adventists. Cancer . 1989;;64:591-597.

Colditz GA, Stampfer MJ, Willet WC, et al. Type of postmenopausal hormone use and risk of breast cancer: 12-year follow-up from the Nurses' Study. Cancer Causes Control . 1992;;3:433-439.

Schairer C, Byrne C, Keyl PM, Brinton LA, Sturgeon SR, Hoover RN. Menopausal estrogen and estrogen-progestin replacement therapy and risk of breast cancer. Cancer Causes Control . 1994;;5:491-500.

Risch HA, Howe GR. Menopausal hormone usage and breast cancer in Saskatchewan: a record-linkage cohort study. Am J Epidemiol . 1994;;139:670-683.

Ewertz M. Influence of non-contraceptive exogenous and endogenous sex hormones on breast cancer risk in Denmark. Int J Cancer . 1988;;42:832-838.

Yang CP, Daling JR, Band PR, Gallagher RP, White E, Weiss NS. Noncontraceptive hormone use and risk of breast cancer. Cancer Causes Control . 1992;;3:475-479.

Colditz GA, Hankinson SE, Hunter DJ, et al. The use of estrogens and progestins and the risk of breast cancer in postmenopausal women. N Engl J Med . 1995;;332: 1589-1593.

Bergkvist L, Adami H-O, Persson I, et al. Prognosis after breast cancer diagnosis in women exposed to estrogen and estrogen-progestogen replacement therapy. Am J Epidemiol . 1989;;130:221-228.

Stanford JL, Weiss NS, Voight LF, Daling JR, Habel LA, Rossing MA. Combined estrogen and progestin hormone replacement therapy in relation to risk of breast cancer in middle-aged women. JAMA . 1995;;274:137-142.

Stanford JL, Thomas DB. Exogenous progestins and breast cancer. Epidemiol Rev . 1993;;15:98-105.

Toniolo PO, Levitz M, Zeleniuch-Jacquotte A, et al. A prospective study of endogenous estrogens and breast cancer in postmenopausal women. J Natl Cancer Inst . 1995;;87:190-197.

AdamiH-O, Persson I, Ekbom A, Wolk A, Pontén J, Trichopoulos D. The etiology and pathogenesis of human breast cancer. Mutat Res . In press.

Landgren BM. Estrogens and gestagens: pharmacokinetic and pharmacodynamic aspects. In: Pharmacological Treatment of the Climacteric Syndrome . Stockholm, Sweden: National Board of Health and Welfare, Drug Information Committee; 1990;;3:71-86.

Adami H-O. Long-term consequences of estrogen and estrogen-progestin replacement. Cancer Causes Control . 1992;;3:83-90.

Barrett-Connor E, Laakso M. Ischemic heart disease risk in postmenopausal women: effects of estrogen use on glucose and insulin levels. Arteriosclerosis . 1990;; 10:581-584.

Spector TD, Brennan P, Harris P, Studd JW, Sieman AJ. Does estrogen replacement therapy protect against rheumatoid arthritis? J Rheumatol . 1991;;18: 1473-1476.

The Writing Group for the PEPI Trial. Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women: the Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial. JAMA . 1995;;273:199-208.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal