Impact of menopausal hormone‐replacement therapy on clinical and laboratory characteristics of breast cancer

Abstract

Hormone-replacement therapy (HRT) is widely used by post-menopausal women. Although this treatment may slightly increase the incidence of breast cancer, more and more cases are diagnosed while women are taking HRT. The purpose of this study was to ascertain the influence of HRT on prognostic factors and outcome of breast cancer. Data on all breast-cancer patients, including precise information on HRT, was prospectively and systematically recorded in a data base. From 1985 to 1995, 1379 post-menopausal women fulfilled the eligibility criteria for this study. All were treated by us (P.B. and L.P.) in our ward of a large public hospital of Marseilles, France. The clinical features, laboratory findings and survival rates in 142 HRT users who developed breast cancer while being treated were compared with those of 284 matched never user breast-cancer patients. Patients who developed breast cancer during HRT had fewer locally advanced cancers and smaller and better-differentiated cancers. Lymph-node involvement was significantly less frequent in the user group than in the non-user group (non-significant). Estradiol receptivity was both qualitatively and quantitatively lower in users. There was no significant difference with regard to recurrence and metastasis-free survival and overall survival. We conclude that HRT does not affect the prognosis of breast cancer. Regular surveillance during HRT allows early detection of smaller lesions. The higher number of welldifferentiated cancers and the distribution of hormone receptivity may reflect interaction between neoplastic tissue and exogenous hormones.

Estradiol as an anti-aromatase agent in human breast cancer cells

“…The paradoxical effects of E 2 in blocking both the aromatase and sulfatase activities could be related to estrogen replacement therapy (ERT), a treatment that has been observed to have either no effect or to slightly increase breast cancer incidence [32] but significantly decrease mortality [33][34][35][36][37].…”

Expression of Estrogen Receptor Alpha and Beta in Breast Cancers of Pre- and Post-menopausal Women

“…Their findings indicate that post-menopausal HRT is associated with distinct expression profiles of 276 genes, related to better recurrence-free survival and lower ER protein levels. Recent studies indicate less aggressive tumor characteristics in HRT users [29][30][31][32][33][34][35][36][37][38][39][40]. The current study suggests that menopause may influence the expression of both molecular forms of the estrogen receptor in breast cancer.…”

Comparison of the efficacy and tolerability of a new once-a-week matricial estradiol transdermal system (Estrapatch® 40 and Estrapatch® 60) with a twice week system

“…Women (421) The estradiol patches were administered continuously during six 28-day cycles; the opposing sequential (days [15][16][17][18][19][20][21][22][23][24][25][26][27][28] progestin in non-hysterectomized women was oral Milligynon (1.2 mg od). The main reason that women are prescribed combined rather than estrogen-only HRT is because of the increased risk of endometrial cancer associated with use of estrogen alone.…”

“…This epidemiologic evidence about the role of progestins in breast cancer is conflicting and remains controversial [16]; there is no definitive evidence that progestins act in the pathogenesis of breast cancer and studies have consistently documented that HRT use is associated with improved mortality and survival rates for women with breast cancer [17][18][19] and have demonstrated that HRT users have smaller tumors [20] that are more well differentiated [21] and more localized [22]. It has also been shown that progestins are proliferative when administered sequentially and antiproliferative when administered continuously.…”