Estrogen for the Treatment and Prevention of Breast Cancer

Abderrahman, Balkees; Jordan, V. Craig

doi:10.1097/ppo.0000000000000600

Cited by 4 publications

(2 citation statements)

References 64 publications

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“…Preclinical studies suggest one contributing factor is a progestin-induced, persistent increase in the breast epithelium stem cell pool 19 . Comprehensive presentation of potential mediating mechanisms is reported elsewhere 20,21 …”

Section: Whi Randomized Trial Resultsmentioning

confidence: 99%

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The Women's Health Initiative randomized trials of menopausal hormone therapy and breast cancer: findings in context

Chlebowski¹,

Aragaki

2023

Menopause

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Importance and Objective: The menopausal hormone therapy (MHT) association with breast cancer has been controversial for more than 40 years. Most recently, findings from cohort studies have been discordant compared with those from the Women's Health Initiative (WHI) randomized trials. In cohort studies, both estrogen therapy and estrogen plus progestin were associated with higher breast cancer incidence. In contrast, in the WHI randomized trials, findings for estrogen plus progestin are concordant with cohort study reports, whereas estrogen therapy significantly reduced breast cancer incidence. In addition, concerns have been raised regarding the WHI findings from both trials. In this report, we briefly summarize findings for MHT on breast cancer from cohort studies and the WHI randomized trials. The report focus is addressing, point-by-point, concerns raised regarding the WHI findings.Methods: For cohort studies, we relied on the latest findings from (1) the meta-analysis of the Collaborative Group on Hormonal Factors in Breast Cancer and (2) the Million Women's Study. To identify commentaries and editorials, "Menopause" and "Climacteric" were searched from 2002 to present; PubMed and Google Scholar were searched for commentaries, editorials, and breast cancer, MHT, estrogen, conjugated equine estrogen, estradiol, "hormone replacement therapy," and "HRT."Discussion and Conclusions: Thirty commentaries challenging WHI findings were identified. All were reviewed, and issues needing response were identified. Findings from the meta-analysis from the Collaborative Group on Hormonal Factors in Breast Cancer and the Million Women Study were summarized and compared with finding in the two WHI randomized trials evaluating estrogen therapy and estrogen plus progestin. Based on the randomized clinical trials, estrogen therapy, for women with prior hysterectomy, decreases breast cancer incidence and mortality. In contrast, estrogen plus progestin increases breast cancer incidence, which persists through two decades. Women considering estrogen plus progestin use for vasomotor symptoms should understand the breast cancer risk.

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Section: Whi Randomized Trial Resultsmentioning

confidence: 99%

“…19 Comprehensive presentation of potential mediating mechanisms is reported elsewhere. 20,21 Estrogen therapy in women with prior hysterectomy…”

Section: Estrogen Plus Progestinmentioning

confidence: 99%

The Women's Health Initiative randomized trials of menopausal hormone therapy and breast cancer: findings in context

Chlebowski¹,

Aragaki

2023

Menopause

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Randomized trials of estrogen-alone and breast cancer incidence: a meta-analysis

Chlebowski,

Aragaki,

Pan

et al. 2024

Breast Cancer Res Treat

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Fine-Tuning Adjuvant Endocrine Therapy for Early-Stage Breast Cancer: An Expert Consensus on Open Issues for Future Research

Conforti,

Pala,

De Pas

et al. 2023

Clinical Cancer Research

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After decades of research, improving the efficacy of adjuvant endocrine therapy (ET) for early-stage breast cancer (BC) becomes increasingly difficult. Beyond technological breakthroughs and the availability of new classes of drugs, further improvement of adjuvant ET will require applying a rigorous research approach in poorly investigated areas. We critically discuss some key principles that should inform future research to improve ET efficacy, including identifying specific subgroups of patients who can benefit from escalating or de-escalating approaches, optimizing available and new treatment strategies for different clinical contexts, and dissecting the direct and indirect biological effects of therapeutic interventions. Four main issues regarding adjuvant ET were identified as relevant areas where a better application of such principles can provide positive results in the near future: i) tailoring the optimal duration of adjuvant ET; ii) optimizing ovarian function suppression for pre-menopausal women; iii) dissecting the biological effects of estrogen receptor manipulation; and iv) refining the selection of patients to candidate for treatments escalation.

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Estrogen for the Treatment and Prevention of Breast Cancer

Cited by 4 publications

References 64 publications

The Women's Health Initiative randomized trials of menopausal hormone therapy and breast cancer: findings in context

The Women's Health Initiative randomized trials of menopausal hormone therapy and breast cancer: findings in context

Randomized trials of estrogen-alone and breast cancer incidence: a meta-analysis

Fine-Tuning Adjuvant Endocrine Therapy for Early-Stage Breast Cancer: An Expert Consensus on Open Issues for Future Research

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