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ABSTRACT
Objectives To determine any association between hormonal replacement therapy (HRT) usage and breast cancer recurrence and survival rates in women who were premenopausal at the time of diagnosis of breast cancer.
Methods The study group comprised 524 women who were diagnosed with breast cancer when they were premenopausal. Of these, 277 women reached menopause before recurrence of the disease, being lost to follow-up, or reaching the end of the study. In this group, 119 women took HRT to control menopausal symptoms. The majority took combined continuous estrogen-progestin treatment. Times from diagnosis to cancer recurrence or new breast cancer, to death from all causes, and to death from primary tumor were compared between HRT users and non-users.
Results Women who used HRT after their menopause had an adjusted relative risk of recurrence or new breast cancer of 0.75 (95% confidence interval (CI), 0.29-1.95) compared to that of non-users. The relative risk of death from all causes was 0.36 (95% CI, 0.11-1.16) and that of death from primary tumor was 0.24 (95% CI, 0.05-1.14).
Conclusion HRT use in women who were premenopausal at the diagnosis of primary invasive breast cancer is not associated with worse outcomes in terms of breast cancer recurrence or mortality.
Key words: MENOPAUSE, HORMONE REPLACEMENT THERAPY, BREAST CANCER, ESTROGEN PLUS PROGESTIN
INTRODUCTION
Current epidemiological data on healthy women indicate that current users of postmenopausal hormone replacement therapy (HRT) have an increased risk of breast cancer. Controversy still exists whether hormonal therapy causes breast cancer or promotes growth of pre-existing tumors1,2.
Breast cancer has been viewed as an absolute or relative contraindication to HRT in symptomatic women3,4. Concerns about promoting growth and/or disseminating occult malignant cells have been the primary considerations, despite there being no direct evidence to indicate that HRT worsens prognosis. To the best of our knowledge, no studies of breast cancer patients who have been prescribed HRT have shown an increased risk of tumor recurrence or death from progressive disease5-16. Since it has been suggested that breast cancer in young women is more aggressive than in women who are postmenopausal at diagnosis17, we believed it would be important to conduct a study of women who were premenopausal when diagnosed, some of whom would go on to use HRT....