The characteristics of malignant breast tumors in hormone replacement therapy users versus nonusers

Pappo, Itzhak; Meirshon, Ioana; Karni, Tamar; Siegelmann-Danielli, Nava; Stahl-Kent, Varda; Sandbank, Judith; Wasserman, Ilan; Halevy, Ariel

doi:10.1007/bf02524346

Cited by 20 publications

(9 citation statements)

References 35 publications

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“…Several observational studies have reported that breast cancers in hormone users are diagnosed earlier and have histologic and other features that are associated with a better prognosis (Holli et al, 1998;Sacchini et al, 2002;Daling et al, 2003;Pappo et al, 2004) However, results from the Women's Health Initiative (WHI), the only randomised controlled trial of hormone use, showed that hormone users were diagnosed with larger tumours and more likely to have positive lymph nodes (Chlebowski et al, 2003). The study was underpowered to access the effect on grade, histology and hormone receptor status.…”

Section: Discussionmentioning

confidence: 99%

Mortality following development of breast cancer while using oestrogen or oestrogen plus progestin: a computer record-linkage study

2005

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The literature on the relationship between breast cancer mortality and postmenopausal oestrogen and combined oestrogen/ progestin therapy is seemingly contradictory. This study explored survival after exposure to oestrogen or oestrogen plus progestin at or in the year prior to breast cancer diagnosis. Information on patients first diagnosed with invasive breast cancer between 1993 and 1998 was linked with outpatient pharmacy data from 1992 to 2000. Patients were classified according to use of oestrogen alone or oestrogen plus progestin at or in the year prior to diagnosis. Compared to nonusers, and adjusting for age at diagnosis, race/ethnicity, tumour size and grade, oestrogen receptor status, surgery status, and chemotherapy and hormone therapy for breast cancer treatment, oestrogen plus progestin users had lower all-cause mortality (stage I hazard ratio ( Our findings suggest, relative to nonusers, a lower risk of death from all causes and from breast cancer in patients who were diagnosed with breast cancer while exposed to oestrogen plus progestin, but not in patients exposed to oestrogen only.

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Section: Discussionmentioning

confidence: 99%

Mortality following development of breast cancer while using oestrogen or oestrogen plus progestin: a computer record-linkage study

2005

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“…The lower stage at diagnosis probably reflects also a higher awareness of HRT users for frequent clinical and mammographic screening. Furthermore, women who use HRT tend to belong to the higher socioeconomic classes and have easier access to health facilities (Pappo et al 2004). Despite the less aggressive biological features of ILC, several studies have not found significant differences in disease-free and OS when compared with IDC (Winchester et al 1998, Mersin et al 2003, Arpino et al 2004, Korhonen et al 2004, Molland et al 2004, Ugnat et al 2004, Santiago et al 2005.…”

Section: Discussionmentioning

confidence: 99%

Increased incidence of lobular breast cancer in women treated with hormone replacement therapy: implications for diagnosis, surgical and medical treatment

Biglia¹,

Mariani²,

Sgrò³

et al. 2007

Endocr Relat Cancer

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A growing body of evidence support the association between the use of hormone replacement therapy (HRT) and a higher risk of both invasive lobular carcinoma (ILC) and invasive ductal-lobular mixed carcinoma (IDLC). Overall biological and clinical features of ILC entail a more cautious diagnostic and therapeutic approach as compared with invasive ductal carcinoma (IDC). ILCs are more frequently multifocal, multicentric and/or bilateral. Mammography and ultrasound show, therefore, significant limitations, while the higher sensitivity of magnetic resonance imaging in the detection of multifocal and/or multicentric lesions seems to improve the accuracy of preoperative staging of ILCs. Early diagnosis is even more challenging because the difficult in the localization and the sparse cellularity of lobular tumours may determine a false negative core biopsy. ILC is characterized by low proliferative activity, C-ErbB-2 negativity, bcl-2 positivity, p53 and VEGF negativity, oestrogen and progesterone positive receptors, low grade and low likelihood of lymphaticvascular invasion. However, this more favourable biological behaviour does not reflect into a better disease-free and overall survival as compared with IDC. Since lobular histology is associated with a higher risk of positive margins, mastectomy is often preferred to breast conservative surgery. Moreover, only few patients with ILC achieve a pathologic response to preoperative chemotherapy and, therefore, in most patients mastectomy can be regarded as the safer surgical treatment. The preoperative staging and the follow-up of patients with ILC are also complicated by the particular metastatic pattern of such histotype. In fact, metastases are more frequently distributed to the gastrointestinal tract, peritoneum/retroperitoneum and gynaecological organs than in IDC.

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“…Com a crescente utilização da TH, inúmeros estudos relacionam-na com o aumento na incidência do câncer de mama [3][4][5]7,11 . Entretanto, com a suspensão da terapêutica, o risco para o câncer de mama se reduz, sugerindo que a estrogenioterapia promoveria o crescimento de células tumorais dormentes, tornando o tumor clinicamente detectável mais precocemente 13,18 . No presente estudo, as pacientes com diagnóstico de câncer de mama que usaram TH apresentaram menor faixa etária e menor tempo de menopausa.…”

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“…No presente estudo, não foi observada correlação entre o uso de TH e a expressão dos oncogenes c-erbB-2 e p53. A expressão do oncogene c-erbB-2 é encontrada em aproximadamente 25% dos tumores, significando pior prognóstico para as pacientes com câncer de mama 13 . Em 2002, Hur et al 25 constataram que os tumores das pacientes usuárias de TH foram significativamente menores, com menor comprometimento linfonodal e com menor expressão para c-erbB-2, quando comparadas a não usuárias.…”

Section: Variáveisunclassified

“…Por outro lado, estudos recentes encontraram melhores indicadores de prognóstico do cân-cer de mama em mulheres sob TH. Os tumores que se desenvolvem em usuárias são menores, mais diferenciados e favoráveis histologicamente, além de pouco avançados clinicamente e com menor taxa de linfonodos positivos 12,13 . Freqüen-temente expressam receptor para estrogênio, indicando melhor prognóstico 14,15 .…”

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Influência da terapêutica hormonal prévia sobre os indicadores de prognóstico do câncer de mama em mulheres na pós-menopausa

Nahás¹,

Lindsey²,

Uemura³

et al. 2005

Rev. Bras. Ginecol. Obstet.

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RESUMOObjetivo: avaliar a influência da terapêutica hormonal (TH) prévia sobre alguns indicadores de prognóstico do câncer de mama, em pacientes na pós-menopausa. Métodos: estudo transversal por meio da aplicação de questionários e levantamento de prontuários. Foram entrevistadas 157 pacientes com diagnóstico de câncer de mama na pós-menopausa, registrando-se dados clínicos, antecedentes pessoais e familiares, uso de TH e mamografias. Nos prontuários foram obtidas informações sobre o câncer de mama quanto ao diâmetro do tumor, tipo de cirurgia e estudo imuno-histoquímico. Para a estatística empregou-se ANOVA e teste do χ 2 . Resultados: 38,2% das pacientes eram ex-usuárias de TH e 61,8% não usuárias. O tempo médio de uso da TH foi de 3,7±3,6 anos. As ex-usuárias eram de menor faixa etária e com menor tempo de menopausa quando comparadas às não usuárias (p<0,05). Constatou-se que 26,8% das pacientes apresentavam antecedentes familiares de câncer de mama, em ambos os grupos. Entre as ex-usuárias de TH, 43,3% foram submetidas a mamografias prévias, ao passo que entre as não usuárias, apenas 11,3% (p<0,001). O diâmetro médio do tumor foi menor entre as ex-usuárias de TH (2,3±1,1 cm), com predomínio de quadrantectomias (60%), quando comparadas as não usuárias (3,3±1,5 cm e 32%, respectivamente) (p<0,001). No estudo imuno-histoquímico, observou-se correlação positiva entre a presença de receptores de estrogênio e progesterona positivos e o uso de TH (p<0,001). Não houve correlação entre TH e c-erbB-2 e p53. Conclusão: nesta casuística, as mulheres na pós-menopausa que usaram TH prévia ao diagnóstico de câncer de mama apresentaram indicadores de prognóstico mais favoráveis quando comparadas às não usuárias. PALAVRAS-CHAVE: Menopausa; Terapêutica hormonal; Neoplasias mamáriasInfluência da terapêutica hormonal prévia sobre os indicadores de prognóstico do câncer de mama em mulheres na pós-menopausa ABSTRACT Purpose: to evaluate the influence of previous hormonal therapy (HT) on breast cancer prognostic markers in postmenopausal women. Methods: a cross-sectional study was carried out, applying questionnaires and medical record surveys of 157 postmenopausal patients with breast cancer diagnosis. Clinical data, personal and familiar history, HT use, and mammograms were investigated. The medical record surveys yielded information about tumor size, imunohistochemical data, and type of surgery. Statistical analysis was performed using ANOVA and the χ 2 test. Results: 38.2% of the patients were HT ex-users and 61.8% were non-users. Mean time of HT use was 3.7±3.6 years. HT ex-users were younger and with a shorter menopause time than non-users (p<0.05). 26.8% of the patients reported previous cases of breast cancer in their families, with no difference between the groups. Of the HT ex-users, 43.3% had previous mammograms, while of the non-users, only 11.3% (p<0.001). Mean tumor size was smaller in HT ex-users (2.3±1.1 cm) than in non-users (3.3±1.5cm) (p<0.001). The conservative surgeries (quadrantectomies) were predominant in H...

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The characteristics of malignant breast tumors in hormone replacement therapy users versus nonusers

Abstract: Breast tumors in HRT users vs. nonusers were of a significantly lower stage and grade and accounted for a higher number of favorable histological types, but all other parameters were similar in the two groups.

Cited by 20 publications

References 35 publications

Mortality following development of breast cancer while using oestrogen or oestrogen plus progestin: a computer record-linkage study

Mortality following development of breast cancer while using oestrogen or oestrogen plus progestin: a computer record-linkage study

Increased incidence of lobular breast cancer in women treated with hormone replacement therapy: implications for diagnosis, surgical and medical treatment

Influência da terapêutica hormonal prévia sobre os indicadores de prognóstico do câncer de mama em mulheres na pós-menopausa

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