Breast Cancer Research and Treatment

, Volume 163, Issue 2, pp 363–373 | Cite as

Estrogen–progestin use and breast cancer characteristics in lean and overweight postmenopausal women

  • Olof J. Kjartansdottir
  • Lara G. Sigurdardottir
  • Elinborg J. Olafsdottir
  • Jon G. Jonasson
  • Giske Ursin
  • Laufey Tryggvadottir
Epidemiology
  • 159 Downloads

Abstract

Purpose

Breast cancer associated with estrogen–progestin (EP) therapy may have more favorable characteristics than cancer in never users, but results are conflicting. It is not well known either whether Body Mass Index (BMI) modifies this association. We investigated breast cancer characteristics in EP users for lean (BMI < 25 kg/m2) and overweight women (BMI ≥ 25 kg/m2).

Methods

The Icelandic Cancer Detection Clinic cohort, with information on breast cancer risk factors for 90% of Icelandic women, was linked with the population-based Icelandic Cancer Registry. A total of 781 women with invasive breast cancer diagnosed 51 years or older were matched with 7761 controls from the cohort. Conditional logistic regression was used for estimating adjusted odds ratios (OR) and 95% confidence intervals (CI) according to tumor characteristics, stratified by BMI. Polytomous logistic regression was applied in a case-only analysis for testing whether the risk associated with EP use differed according to tumor characteristics.

Results

Ever EP users had a twofold higher risk of breast cancer compared with never users (OR 2.05, 95% CI 1.71–2.45). In lean women, EP use was significantly less likely to be associated with grade 2 or 3 tumors than grade 1 tumors, contrary to overweight women for whom risk was increased irrespective of grade. EP use in overweight women was associated with a higher risk of lobular than ductal cancer (OR 2.75, 95% CI 1.29–5.87).

Conclusion

Among lean EP users, tumor characteristics were more favorable than among never users. This effect was not observed for overweight women.

Keywords

Menopausal hormone therapy Breast cancer Body Mass Index Tumor characteristics Estrogen Progesterone 

Abbreviations

BMI

Body Mass Index

CDC

Icelandic Cancer Detection Clinic

CI

Confidence interval

E-only

Estrogen-only

EP

Estrogen–progestin

ER±

Estrogen receptor-positive/negative

HT

Hormone therapy

ICR

Icelandic Cancer Registry

OR

Odds ratio

PR±

Progesterone receptor-positive/negative

Notes

Acknowledgements

We are grateful to Dr. Jens Gudmundsson, Department of Obstetrics and Gynecology, University Hospital, Reykjavık, for valuable help in the preparatory phase of this study and to the women who participated in the CDC study. The project was supported by the Icelandic Cancer Society.

Funding

This study was funded by the Icelandic Cancer Society.

Compliance with ethical standards

Ethical approval

Approval was obtained for this study from the Bioethics Committee of Iceland (VSN-15-003) and the Icelandic Data Protection Authority (2014121741AT).

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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Olof J. Kjartansdottir
    • 1
    • 2
    • 3
  • Lara G. Sigurdardottir
    • 4
  • Elinborg J. Olafsdottir
    • 3
  • Jon G. Jonasson
    • 5
    • 6
  • Giske Ursin
    • 7
    • 8
    • 9
  • Laufey Tryggvadottir
    • 3
    • 6
  1. 1.Department of Clinical OncologyBeatson West of Scotland Cancer CentreGlasgowUK
  2. 2.Department of Internal MedicineLandspitali University HospitalReykjavikIceland
  3. 3.Icelandic Cancer RegistryIcelandic Cancer SocietyReykjavikIceland
  4. 4.Department of Education and PreventionIcelandic Cancer SocietyReykjavikIceland
  5. 5.Department of PathologyLandspitali University HospitalReykjavikIceland
  6. 6.Faculty of MedicineUniversity of IcelandReykjavikIceland
  7. 7.Cancer Registry of Norway, Institute of Population-Based Cancer ResearchOsloNorway
  8. 8.Department of Preventive MedicineUniversity of Southern CaliforniaLos AngelesUSA
  9. 9.Department of Nutrition, Institute of Basic Medical SciencesUniversity of OsloOsloNorway

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