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Menopausal hormone therapy and the risk of breast cancer by histological type and race: a meta-analysis of randomized controlled trials and cohort studies

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

This meta-analysis investigated the association between the risk of breast cancer and hormone replacement therapy (HRT). Various stratified analyses were performed according to race (Asian/Westerner), HRT type [all hormone therapies, estrogen-only therapy (ET), or combined estrogen–progestin therapy (EPT)], histological breast cancer type (ductal/lobular/mixed ductal–lobular), and estrogen receptor status (ER-positive/ER-negative).

Methods

A literature search was performed using Pubmed, Embase, and KoreaMed. Twenty-five epidemiological studies including 23 cohort studies and two randomized controlled trials were included in this meta-analysis.

Results

Using a random-effects model, HRT use was found to be positively associated with the risk of breast cancer with a pooled hazard ratio (HR) of 1.33 [95% confidence interval (CI) 1.24, 1.44]. Compared with ET, EPT was more strongly associated with breast cancer risk. EPT was associated with both ductal and lobular breast cancer risks [for ductal breast cancer, HR = 1.51 (95% CI 1.28, 1.78); for lobular breast cancer, HR = 1.38 (95% CI 1.20, 1.60)]. According to ER status, all HRTs were associated with the risk of ER-positive breast cancer, but not with that of ER-negative breast cancer.

Conclusions

Asian HRT users had a higher risk of breast cancer than western HRT users. Both ET and EPT were significantly associated with the risk of all breast cancer histological types and ER-positive breast cancer.

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Abbreviations

CI:

Confidence interval

EGF:

Epidermal growth factor

EPT:

Combined estrogen–progestin therapy

ER:

Estrogen receptor

ET:

Estrogen-only therapy

Her2/neu:

Human epidermal growth factor receptor-2

HR:

Hazard ratio

HRT:

Hormone replacement therapy

IGF:

Insulin-like growth factor

RR:

Risk ratio

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Author notes

  1. Sohyun Kim and Yeonsook Ko have contributed equally to this work as co-first authors.

Authors and Affiliations

  1. Graduate School of Industrial Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea

    Sohyun Kim, Yeonsook Ko, Hwa Jeong Lee & Jung-eun Lim

  2. College of Pharmacy, Ewha Womans University, Seoul, Republic of Korea

    Hwa Jeong Lee & Jung-eun Lim

  3. Institute for Health Promotion & Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea

    Jung-eun Lim

Authors
  1. Sohyun Kim
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  2. Yeonsook Ko
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  3. Hwa Jeong Lee
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  4. Jung-eun Lim
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Corresponding authors

Correspondence to Hwa Jeong Lee or Jung-eun Lim.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

This study complies with the current laws of the country in which it was performed.

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Kim, S., Ko, Y., Lee, H.J. et al. Menopausal hormone therapy and the risk of breast cancer by histological type and race: a meta-analysis of randomized controlled trials and cohort studies. Breast Cancer Res Treat 170, 667–675 (2018). https://doi.org/10.1007/s10549-018-4782-2

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  • DOI: https://doi.org/10.1007/s10549-018-4782-2

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