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ORIGINAL RESEARCH |
From the Population Studies and Prevention Program, Karmanos Cancer Institute at Wayne State University, Detroit, Michigan; Department of Obstetrics and Gynecology, Henry Ford Health Systems, Detroit, Michigan; Fred Hutchinson Cancer Research Center, Seattle, Washington; Karmanos Cancer Institute at Wayne State University, Department of Internal Medicine, Detroit, Michigan; Center for Clinical Epidemiology and Biostatistics and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Preventive Medicine, University of Southern California, Los Angeles, California; Divisions of Reproductive Health and Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; and Contraception and Reproductive Health Branch, Center for Population Research, National Institute of Child Health and Human Development, Bethesda, Maryland.
Address reprint requests to: Linda K. Weiss, PhD, Cancer Centers Branch, Office of Centers, Training and Resources, National Cancer Institute, 6116 Executive Boulevard, Suite 700, Bethesda, MD 20892-8345; E-mail: lw187q{at}nih.gov.
OBJECTIVE: Hormone replacement therapy (HRT) has increased in the United States over the past 2 decades in response to reports of long-term health benefits. A relationship between HRT and breast cancer risk has been observed in a number of epidemiological studies. In 2002, the Women’s Health Initiative Randomized Controlled Trial reported an association between continuous combined HRT and breast cancer risk. The objective of this study was to examine the association between breast cancer risk and HRT according to regimen and duration and recency of use.
METHODS: A multicenter, population-based, case-control study was conducted in five United States metropolitan areas from 1994 to 1998. Analyzed were data from 3823 postmenopausal white and black women (1870 cases and 1953 controls) aged 35–64 years. Odds ratios (ORs) were calculated as estimates of breast cancer risk using standard, unconditional, multivariable logistic regression analysis. Potential confounders were included in the final model if they altered ORs by 10% or more. Two-sided P values for trend were computed from the likelihood ratio statistic.
RESULTS: Continuous combined HRT was associated with increased breast cancer risk among current users of 5 or more years (1.54; 95% confidence interval 1.10, 2.17). Additionally, a statistically significant trend indicating increasing breast cancer risk with longer duration of continuous combined HRT was observed among current users (P = .01). There were no positive associations between breast cancer risk and other HRT regimens.
CONCLUSION: Our data suggest a positive association between continuous combined HRT and breast cancer risk among current, longer term users. Progestin administered in an uninterrupted regimen may be a contributing factor. Risk dissipates once use is discontinued.
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