Age-related variation in the relationship between menopausal hormone therapy and the risk of dying from breast cancer.

Reding, Kerryn W and Doody, David R and McTiernan, Anne and Hsu, Li and Davis, Scott and Daling, Janet R and Porter, Peggy L and Malone, Kathleen E (2010) Age-related variation in the relationship between menopausal hormone therapy and the risk of dying from breast cancer. Breast cancer research and treatment. ISSN 1573-7217 (In Press)

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Abstract

Multiple past studies have reported a reduced risk of breast cancer-related mortality (BCM) in relation to pre-diagnostic use of hormone therapy (HT); however, the extent to which this reduction is due to heightened screening or tumor biology is unknown. Using a population-based cohort of 1,911 post-menopausal women diagnosed with invasive breast cancer at ages 45-79 from 1993 to 1999, we investigated the extent to which the reduced risk in BCM observed in relation to HT might be explained by screening patterns or tumor features. Estrogen-progestin therapy (EPT) use was associated with a decreased risk of BCM (after adjustment for age, study, mammography, stage, and treatment), but only among older women (ever use: ≥65 years: HR = 0.45 [95% CI 0.26-0.80]; <65 years: HR = 1.03 [95% CI 0.60-1.79]). Estrogen-alone therapy (ET) use was not associated with risk of BCM (ever use: ≥65 years: HR = 0.76 [95% CI 0.51-1.12]; <65 years: HR = 1.20 [95% CI 0.71-2.02]). HT users had a much greater frequency of mammography (P value <0.001). EPT use was associated with tumor characteristics related to improved prognosis in older women after adjustment for screening, including an inverse association with poorly differentiated tumors (OR = 0.57 [95% CI 0.38-0.85]) and an association with lobular tumors (OR = 1.68 [95% CI 1.07-2.65]). Beyond the influence of EPT use on screening uptake, these data indicate that the improved survival associated with pre-diagnostic EPT use may be due in part to the development of more favorable tumor characteristics.

Item Type:	Article or Abstract
Additional Information:	The final publication is available at www.springerlink.com
DOI:	10.1007/s10549-010-1174-7
PubMed ID:	20878463
NIHMSID:	NIHMS258775
PMCID:	PMC3059400
Grant Numbers:	R01 CA098858., 2 T32 CA 09168
Keywords or MeSH Headings:	Age Factors Aged Breast Neoplasms/chemically induced* Breast Neoplasms/mortality* Cell Differentiation Estrogens/metabolism Female Hormone Replacement Therapy/adverse effects* Hormones/therapeutic use* Humans Mammography/methods Menopause Middle Aged Odds Ratio Progestins/metabolism Risk
Subjects:	Diseases > Solid tumors > Breast cancer
Depositing User:	Library Staff
Date Deposited:	07 Jan 2011 18:28
Last Modified:	14 Feb 2012 14:43
URI:	http://authors.fhcrc.org/id/eprint/472

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