Long‐term surveillance of mortality and cancer incidence in women receiving hormone replacement therapy

Hunt, KK; Mp, Vessey; McPherson, Klim; Coleman, Megan

doi:10.1016/0020-7292(88)90394-3

Cited by 50 publications

(76 citation statements)

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“…Numerous epidemiological studies on the risk of breast cancer for postmenopausal women after treat ment with HRT, either oestrogens alone or a com bina tion of oestrogens and progestagens, have been con ducted [22][23][24][25][26][27][28]. The results of these studies are contra dictory.…”

Section: Discussionmentioning

confidence: 99%

Mammographic changes in postmenopausal women on hormonal replacement therapy

et al. 1997

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Abstract.the extent was to investigate the effects of hormonal replacement on in postmenopausal women. In a hospital-based study examinations of 81 women were evaluated retrospectively, before and af ter 1-2 years of treatment with oestrogens or a com bination of oestrogens and progestagens. Each indi vidual mammographie film was examined separately, and the glandular tissue was classified according to a a screening-centrebased study two consecutive mammograms, with a 2-year interval, of 645 women, of whom 70 were using some kind of hormone therapy, were evaluated retro spectively. In the hospital-based study 31 % of pa tients treated with combination H R T showed an increase m tibroglandular tissue 8.7 % in the group treated with oestrogens alone.was statistically significant {p = 0.046). In the screening-based study 14.3 % of the wo men using hormonal therapy showed an increase, whereas in the non-users no increase was found (p = 1.24 x 10~l°). After beginning H R T many women (between 14 and 25 % in our experience) can be exincrease in be aware of the aetiology of such changes, and can obtain information on H R T most conveniently by

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Section: Discussionmentioning

confidence: 99%

Mammographic changes in postmenopausal women on hormonal replacement therapy

et al. 1997

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“…Recent epidemiological data from the U.K. would support this; Hunt et al (32) observed a 5000 reduction in cardiovascular disease mortality amongst H R T users, similar to the benefit seen in the American studies. However, a large number of women in this study had taken combined sequential oestrogen/progestogen therapy.…”

Section: Hormone Replacement Therapymentioning

confidence: 76%

“…The epidemiological study funded by the Medical Research Council reported that 5 years of H R T usage reduced overall mortality (all cause) by 42",, as compared to national rates (Table 5) (32). Patients in this analysis were on a wide range of H R T preparations and many were on combined oestrogen and progestogen regimens.…”

Section: R I S K / B E N E F I T a N A L Y S I Smentioning

confidence: 86%

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The Long-Term Risks and Benefits of Hormone Replacement Therapy

et al. 1991

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Summary There is increasing awareness that the long‐term consequences of ovarian failure can be prevented or reduced with appropriate hormone replacement therapy (HRT). After the menopause, there is a rapid loss of trabecular bone resulting in a one in two lifetime risk of osteoporotic fracture. HRT prevents this bone loss and decreases the incidence of fracture. A minimum of 5 years treatment is recommended for significant benefit. Epidemiological evidence is accumulating that post‐menopausal oestrogen therapy reduces the risk of cardiovascular disease and stroke by between 30 and 70% even in the presence of established risk factors. Given the prevalence of cardiovascular disease, this is likely to be one of the principle benefits of HRT in the next decade. Concerns about the long‐term safety of HRT have focused on endometrial and breast cancer. The increase in risk of endometrial cancer associated with oestrogen only therapy is abolished with the sequential addition of a progestogen for 10–12 days each cycle. The possible effect of HRT on breast cancer risk has to be considered against the background of a one in 12 lifetime risk of developing this disease. The epidemiological studies investigating this relationship are reviewed in this paper. There is a broad consensus that 5–6 years duration of HRT does not increase breast cancer risk. Longer durations of therapy (10–15 years) have been reported to increase this risk although not all the data are in agreement. Other factors, such as family history and benign breast disease, may also influence the risk of breast cancer. The potential benefits of HRT on mortality and morbidity are enormous. Against this is a possible small increase in breast cancer risk with long‐term usage. Greater awareness of the long term consequences of the menopause and the potential benefits of HRT should be encouraged so that women can make informed decisions about their need for HRT.

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“…More critical is what happens to this cohort of women as they move into older age groups, where the age-specific breast cancer rates are much higher. The Cancer and Steroid Hormone Study data show that women age [45][46][47][48][49][50][51][52][53][54] may actually experience a deficit of breast cancers compared with the numbers e~pected. '~ If this observation proves to be true, one might interpret the early increase in risk as a promotional effect of oral contraceptives on existing breast cancer, such that occult cancer becomes clinically manifest at an earlier age than it otherwise would.…”

Section: Exogenous Hormonesmentioning

confidence: 99%

Steroid hormones and risk of breast cancer

Hulka

Liu

Lininger

1994

Cancer

130

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Background. More than three decades of epidemiologic studies have identified numerous risk factors for breast cancer. These factors have been estimated to account for only 20‐25% of disease occurrence. However, among these factors, several are related to sex steroid hormones: sex of the affected individuals (women), early age of menarche and late age of menopause, parity, late age at first pregnancy, and obesity in postmenopausal women. Methods. Theoretical models and laboratory data support hormonal mechanisms of carcinogenesis, particularly as they relate to proliferation of breast ductal epithelium and terminal end bud growth and differentiation in the lobules of the breast. The recent introduction of biologic markers and molecular epidemiology allows for studies that use laboratory technology in the context of epidemiologic research. Results. This paper summarizes the epidemiologic literature on exogenous hormones, addresses the issue of endogenous steroid hormone levels and estrogen metabolism in serum and breast tissue in premenopausal and postmenopausal women with and without cancer, speaks to the cellular mechanisms of action of estrogen and progesterone, and highlights some of the biologic markers relevant to studies of breast cancer and precursor lesions, with particular emphasis on those that may be hormonally induced or altered. Conclusions. These markers must be better defined in terms of breast cancer pathogenesis. Studies are needed to evaluate the direct effects of behavioral/environmental risk factors on relevant biomarkers as well as to assess the interactions of epidemiologic factors and biomarkers on risk of breast cancer.

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Long‐term surveillance of mortality and cancer incidence in women receiving hormone replacement therapy

Cited by 50 publications

References 0 publications

Mammographic changes in postmenopausal women on hormonal replacement therapy

Mammographic changes in postmenopausal women on hormonal replacement therapy

The Long-Term Risks and Benefits of Hormone Replacement Therapy

Steroid hormones and risk of breast cancer

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