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Age-related variation in the relationship between menopausal hormone therapy and the risk of dying from breast cancer

  • Epidemiology
  • Published:
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Abstract

Multiple past studies have reported a reduced risk of breast cancer-related mortality (BCM) in relation to pre-diagnostic use of hormone therapy (HT); however, the extent to which this reduction is due to heightened screening or tumor biology is unknown. Using a population-based cohort of 1,911 post-menopausal women diagnosed with invasive breast cancer at ages 45–79 from 1993 to 1999, we investigated the extent to which the reduced risk in BCM observed in relation to HT might be explained by screening patterns or tumor features. Estrogen–progestin therapy (EPT) use was associated with a decreased risk of BCM (after adjustment for age, study, mammography, stage, and treatment), but only among older women (ever use: ≥65 years: HR = 0.45 [95% CI 0.26–0.80]; <65 years: HR = 1.03 [95% CI 0.60–1.79]). Estrogen-alone therapy (ET) use was not associated with risk of BCM (ever use: ≥65 years: HR = 0.76 [95% CI 0.51–1.12]; <65 years: HR = 1.20 [95% CI 0.71–2.02]). HT users had a much greater frequency of mammography (P value <0.001). EPT use was associated with tumor characteristics related to improved prognosis in older women after adjustment for screening, including an inverse association with poorly differentiated tumors (OR = 0.57 [95% CI 0.38–0.85]) and an association with lobular tumors (OR = 1.68 [95% CI 1.07–2.65]). Beyond the influence of EPT use on screening uptake, these data indicate that the improved survival associated with pre-diagnostic EPT use may be due in part to the development of more favorable tumor characteristics.

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Abbreviations

AI:

Aromatase inhibitor

BMI:

Body mass index

BCM:

Breast cancer-related mortality

CI:

Confidence interval

CVD:

Cardiovascular disease

ET:

Estrogen-alone therapy

EPT:

Estrogen–progestin therapy

ER:

Estrogen receptor

HR:

Hazards ratio

HT:

Menopausal hormone therapy

OR:

Odds ratio

PR:

Progesterone receptor

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Acknowledgments

The authors would like to thank the study participants for their contribution to this research. This study was supported by NIH Grant R01 CA098858. KWR was supported by the Cancer Epidemiology and Biostatistics Training Grant (2 T32 CA 09168).

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA

    Kerryn W. Reding, Anne McTiernan, Scott Davis, Janet R. Daling, Peggy L. Porter & Kathleen E. Malone

  2. Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M4-C308, Seattle, WA, 98109-1024, USA

    Kerryn W. Reding, David R. Doody, Anne McTiernan, Li Hsu, Scott Davis, Janet R. Daling & Kathleen E. Malone

  3. Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Peggy L. Porter

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  1. Kerryn W. Reding
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Correspondence to Kathleen E. Malone.

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Reding, K.W., Doody, D.R., McTiernan, A. et al. Age-related variation in the relationship between menopausal hormone therapy and the risk of dying from breast cancer. Breast Cancer Res Treat 126, 749–761 (2011). https://doi.org/10.1007/s10549-010-1174-7

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  • DOI: https://doi.org/10.1007/s10549-010-1174-7

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