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

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

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.

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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

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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.

Author information

Authors and Affiliations

  1. Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK

    Olof J. Kjartansdottir

  2. Department of Internal Medicine, Landspitali University Hospital, Reykjavik, Iceland

    Olof J. Kjartansdottir

  3. Icelandic Cancer Registry, Icelandic Cancer Society, Reykjavik, Iceland

    Olof J. Kjartansdottir, Elinborg J. Olafsdottir & Laufey Tryggvadottir

  4. Department of Education and Prevention, Icelandic Cancer Society, Reykjavik, Iceland

    Lara G. Sigurdardottir

  5. Department of Pathology, Landspitali University Hospital, Reykjavik, Iceland

    Jon G. Jonasson

  6. Faculty of Medicine, University of Iceland, Reykjavik, Iceland

    Jon G. Jonasson & Laufey Tryggvadottir

  7. Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway

    Giske Ursin

  8. Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA

    Giske Ursin

  9. Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway

    Giske Ursin

Authors
  1. Olof J. Kjartansdottir
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  2. Lara G. Sigurdardottir
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  3. Elinborg J. Olafsdottir
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  4. Jon G. Jonasson
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  6. Laufey Tryggvadottir
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Corresponding author

Correspondence to Laufey Tryggvadottir.

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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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Kjartansdottir, O.J., Sigurdardottir, L.G., Olafsdottir, E.J. et al. Estrogen–progestin use and breast cancer characteristics in lean and overweight postmenopausal women. Breast Cancer Res Treat 163, 363–373 (2017). https://doi.org/10.1007/s10549-017-4171-2

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  • DOI: https://doi.org/10.1007/s10549-017-4171-2

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