Breast cancer and hormone replacement therapy

Collaborative reanalysis of data from 51 epidemiological studies of 52,705 women with breast cancer and 108,411 women without breast cancer

E. E. Calle, C. W. Heath, R. J. Coates, J. M. Liff, S. Franceschi, R. Talamini, N. Chantarakul, S. Koetsawang, D. Rachawat, A. Morabia, L. Schuman, W. Stewart, M. Szklo, C. Bain, F. Schofield, V. Siskind, P. Band, A. J. Coldman, R. P. Gallagher, T. G. Hislop & 176 others P. Yang, S. W. Duffy, L. M. Kolonel, A. M Y Nomura, M. W. Oberle, H. W. Ory, H. B. Peterson, H. G. Wilson, P. A. Wingo, K. Ebeling, D. Kunde, P. Nishan, G. Colditz, N. Martin, T. Pardthaisong, S. Silpisornkosol, C. Theetranont, B. Boosiri, S. Chutivongse, P. Jimakorn, P. Virutamasen, C. Wongsrichanalai, A. J. McMichael, T. Rohan, M. Ewertz, C. Paul, D. C G Skegg, G. F S Spears, P. Boyle, M. Evstifeeva, J. R. Daling, W. B. Hutchinson, K. Malone, E. A. Noonan, J. L. Stanford, D. B. Thomas, N. S. Weiss, E. White, N. Andrieu, A. Bràmond, F. Clavel, B. Gairard, J. Lansac, L. Piana, R. Renaud, S. R P Fine, H. R. Cuevas, P. Ontiveros, A. Palet, S. B. Salazar, N. Aristizabel, A. Cuadros, A. Bachelot, M. G. Lê, J. Deacon, J. Peto, C. N. Taylor, E. Alfandary, B. Modan, E. Ron, G. D. Friedman, R. A. Hiatt, T. Bishop, J. Kosmelj, M. Primic-Zakelj, B. Ravnihar, J. Stare, W. L. Beeson, G. Fraser, R. D. Bulbrook, J. Cuzick, I. S. Fentiman, J. L. Hayward, D. Y. Wang, R. L. Hanson, M. C. Leske, M. C. Mahoney, P. C. Nasca, A. O. Varma, A. L. Weinstein, T. R. Moller, H. Olsson, J. Ranstam, R. A. Goldbohm, P. A. van den Brandt, R. A. Apelo, J. Baens, J. R. de la Cruz, B. Javier, L. B. Lacaya, C. A. Ngelangel, C. La Vecchia, E. Negri, E. Marubini, M. Ferraroni, M. Gerber, S. Richardson, C. Segala, D. Gatei, P. Kenya, A. Kungu, J. G. Mati, L. A. Brinton, R. Hoover, C. Schairer, R. Spirtas, H. P. Lee, M. A. Rookus, F. E. van Leeuwen, J. A. Schoenberg, M. D. Gammon, E. A. Clarke, L. Jones, K. McPherson, A. Neil, M. Vessey, D. Yeates, V. Beral, D. Bull, B. Crossley, C. Hermon, S. Jones, T. Key, C. Lewis, G. Reeves, R. Collins, R. Doll, R. Peto, P. Hannaford, C. Kay, L. Rosero-Bixby, J. M. Yuan, H. Y. Wei, T. Yun, C. Zhiheng, G. Berry, J. Cooper Booth, T. Jelihovsky, R. MacLennan, R. Shearman, Q. S. Wang, C. J. Baines, A. B. Miller, C. Wall, E. Lund, H. Stalsberg, A. Dabancens, L. Martinez, R. Molina, O. Salas, F. E. Alexander, B. S. Hulka, C. E D Chilvers, L. Bernstein, R. W. Haile, A. Paganini-Hill, M. C. Pike, R. K. Ross, G. Ursin, M. C. Yu, M. P. Longnecker, P. Newcomb, T. M N Farley, S. Holck, O. Meirik, H. O. Adami, R. Bergkvist, I. Persson, F. Levi, K. McPherson, K. Mabuchi, D. Preston, K. Katsouyanni, A. Trichopoulou, D. Trichopoulos, L. Bergkvist

Research output: Contribution to journalArticle

2301 Citations (Scopus)

Abstract

Background. The Collaborative Group on Hormonal Factors in Breast Cancer has brought together and reanalysed about 90% of the worldwide epidemiological evidence on the relation between risk of breast cancer and use of hormone replacement therapy (HRT). Methods. Individual data on 52,705 women with breast cancer and 108,411 women without breast cancer from 51 studies in 21 countries were collected, checked, and analysed centrally. The main analyses are based on 53,865 postmenopausal women with a known age at menopause, of whom 17,830 (33%) had used HRT at some time. The median age at first use was 48 years, and 34% of ever-users had used HRT for 5 years or longer. Estimates of the relative risk of breast cancer associated with the use of HRT were obtained after stratification of all analyses by study, age at diagnosis, time since menopause, body-mass index, parity, and the age a woman was when her first child was born. Findings. Among current users of HRT or those who ceased use 1-4 years previously, the relative risk of having breast cancer diagnosed increased by a factor of 1.023 (95% CI 1.011-1.036; 2p = 0.0002) for each year of use; the relative risk was 1.35 (1.21-1.49; 2p = 0.00001) for women who had used HRT for 5 years or longer (average duration of use in this group 11 years). This increase is comparable with the effect on breast cancer of delaying menopause, since among never-users of HRT the relative risk of breast cancer increases by a factor of 1.028 (95% CI 1.021-1.034) for each year older at menopause. 5 or more years after cessation of HRT use, there was no significant excess of breast cancer overall or in relation to duration of use. These main findings did not vary between individual studies. Of the many factors examined that might affect the relation between breast cancer risk and use of HRT, only a woman's weight and body-mass index had a material effect: the increase in the relative risk of breast dancer associated with long durations of use in current and recent users was greater for women of lower than of higher weight or body-mass index. There was no marked variation in the results according to hormonal type or dose but little information was available about long durations of use of any specific preparation. Cancers diagnosed in women who had ever used HRT tended to be less advanced clinically than those diagnosed in never-users. In North America and Europe the cumulative incidence of breast cancer between the ages of 50 and 70 in never-users of HRT is about 45 per 1000 women. The cumulative excess numbers of breast cancers diagnosed between these ages per 1000 women who began use of HRT at age 50 and used it for 5, 10, and 15 years, respectively, are estimated to be 2 (95% CI 1-3), 6 (3-9), and 12 (5-20). Whether HRT affects mortality from breast cancer is not known. Interpretation. The risk of having breast cancer diagnosed is increased in women using HRT and increases with increasing duration of use. This effect is reduced after cessation of use of HRT and has largely, if not wholly, disappeared after about 5 years. These findings should be considered in the context of the benefits and other risks associated with the use of HRT.

Original languageEnglish
Pages (from-to)1047-1059
Number of pages13
JournalLancet
Volume350
Issue number9084
DOIs
Publication statusPublished - Oct 11 1997

Fingerprint

Hormone Replacement Therapy
Epidemiologic Studies
Breast Neoplasms
Menopause
Body Mass Index
Weights and Measures
North America
Parity

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Breast cancer and hormone replacement therapy : Collaborative reanalysis of data from 51 epidemiological studies of 52,705 women with breast cancer and 108,411 women without breast cancer. / Calle, E. E.; Heath, C. W.; Coates, R. J.; Liff, J. M.; Franceschi, S.; Talamini, R.; Chantarakul, N.; Koetsawang, S.; Rachawat, D.; Morabia, A.; Schuman, L.; Stewart, W.; Szklo, M.; Bain, C.; Schofield, F.; Siskind, V.; Band, P.; Coldman, A. J.; Gallagher, R. P.; Hislop, T. G.; Yang, P.; Duffy, S. W.; Kolonel, L. M.; Nomura, A. M Y; Oberle, M. W.; Ory, H. W.; Peterson, H. B.; Wilson, H. G.; Wingo, P. A.; Ebeling, K.; Kunde, D.; Nishan, P.; Colditz, G.; Martin, N.; Pardthaisong, T.; Silpisornkosol, S.; Theetranont, C.; Boosiri, B.; Chutivongse, S.; Jimakorn, P.; Virutamasen, P.; Wongsrichanalai, C.; McMichael, A. J.; Rohan, T.; Ewertz, M.; Paul, C.; Skegg, D. C G; Spears, G. F S; Boyle, P.; Evstifeeva, M.; Daling, J. R.; Hutchinson, W. B.; Malone, K.; Noonan, E. A.; Stanford, J. L.; Thomas, D. B.; Weiss, N. S.; White, E.; Andrieu, N.; Bràmond, A.; Clavel, F.; Gairard, B.; Lansac, J.; Piana, L.; Renaud, R.; Fine, S. R P; Cuevas, H. R.; Ontiveros, P.; Palet, A.; Salazar, S. B.; Aristizabel, N.; Cuadros, A.; Bachelot, A.; Lê, M. G.; Deacon, J.; Peto, J.; Taylor, C. N.; Alfandary, E.; Modan, B.; Ron, E.; Friedman, G. D.; Hiatt, R. A.; Bishop, T.; Kosmelj, J.; Primic-Zakelj, M.; Ravnihar, B.; Stare, J.; Beeson, W. L.; Fraser, G.; Bulbrook, R. D.; Cuzick, J.; Fentiman, I. S.; Hayward, J. L.; Wang, D. Y.; Hanson, R. L.; Leske, M. C.; Mahoney, M. C.; Nasca, P. C.; Varma, A. O.; Weinstein, A. L.; Moller, T. R.; Olsson, H.; Ranstam, J.; Goldbohm, R. A.; van den Brandt, P. A.; Apelo, R. A.; Baens, J.; de la Cruz, J. R.; Javier, B.; Lacaya, L. B.; Ngelangel, C. A.; La Vecchia, C.; Negri, E.; Marubini, E.; Ferraroni, M.; Gerber, M.; Richardson, S.; Segala, C.; Gatei, D.; Kenya, P.; Kungu, A.; Mati, J. G.; Brinton, L. A.; Hoover, R.; Schairer, C.; Spirtas, R.; Lee, H. P.; Rookus, M. A.; van Leeuwen, F. E.; Schoenberg, J. A.; Gammon, M. D.; Clarke, E. A.; Jones, L.; McPherson, K.; Neil, A.; Vessey, M.; Yeates, D.; Beral, V.; Bull, D.; Crossley, B.; Hermon, C.; Jones, S.; Key, T.; Lewis, C.; Reeves, G.; Collins, R.; Doll, R.; Peto, R.; Hannaford, P.; Kay, C.; Rosero-Bixby, L.; Yuan, J. M.; Wei, H. Y.; Yun, T.; Zhiheng, C.; Berry, G.; Cooper Booth, J.; Jelihovsky, T.; MacLennan, R.; Shearman, R.; Wang, Q. S.; Baines, C. J.; Miller, A. B.; Wall, C.; Lund, E.; Stalsberg, H.; Dabancens, A.; Martinez, L.; Molina, R.; Salas, O.; Alexander, F. E.; Hulka, B. S.; Chilvers, C. E D; Bernstein, L.; Haile, R. W.; Paganini-Hill, A.; Pike, M. C.; Ross, R. K.; Ursin, G.; Yu, M. C.; Longnecker, M. P.; Newcomb, P.; Farley, T. M N; Holck, S.; Meirik, O.; Adami, H. O.; Bergkvist, R.; Persson, I.; Levi, F.; McPherson, K.; Mabuchi, K.; Preston, D.; Katsouyanni, K.; Trichopoulou, A.; Trichopoulos, D.; Bergkvist, L.

In: Lancet, Vol. 350, No. 9084, 11.10.1997, p. 1047-1059.

Research output: Contribution to journalArticle

Calle, EE, Heath, CW, Coates, RJ, Liff, JM, Franceschi, S, Talamini, R, Chantarakul, N, Koetsawang, S, Rachawat, D, Morabia, A, Schuman, L, Stewart, W, Szklo, M, Bain, C, Schofield, F, Siskind, V, Band, P, Coldman, AJ, Gallagher, RP, Hislop, TG, Yang, P, Duffy, SW, Kolonel, LM, Nomura, AMY, Oberle, MW, Ory, HW, Peterson, HB, Wilson, HG, Wingo, PA, Ebeling, K, Kunde, D, Nishan, P, Colditz, G, Martin, N, Pardthaisong, T, Silpisornkosol, S, Theetranont, C, Boosiri, B, Chutivongse, S, Jimakorn, P, Virutamasen, P, Wongsrichanalai, C, McMichael, AJ, Rohan, T, Ewertz, M, Paul, C, Skegg, DCG, Spears, GFS, Boyle, P, Evstifeeva, M, Daling, JR, Hutchinson, WB, Malone, K, Noonan, EA, Stanford, JL, Thomas, DB, Weiss, NS, White, E, Andrieu, N, Bràmond, A, Clavel, F, Gairard, B, Lansac, J, Piana, L, Renaud, R, Fine, SRP, Cuevas, HR, Ontiveros, P, Palet, A, Salazar, SB, Aristizabel, N, Cuadros, A, Bachelot, A, Lê, MG, Deacon, J, Peto, J, Taylor, CN, Alfandary, E, Modan, B, Ron, E, Friedman, GD, Hiatt, RA, Bishop, T, Kosmelj, J, Primic-Zakelj, M, Ravnihar, B, Stare, J, Beeson, WL, Fraser, G, Bulbrook, RD, Cuzick, J, Fentiman, IS, Hayward, JL, Wang, DY, Hanson, RL, Leske, MC, Mahoney, MC, Nasca, PC, Varma, AO, Weinstein, AL, Moller, TR, Olsson, H, Ranstam, J, Goldbohm, RA, van den Brandt, PA, Apelo, RA, Baens, J, de la Cruz, JR, Javier, B, Lacaya, LB, Ngelangel, CA, La Vecchia, C, Negri, E, Marubini, E, Ferraroni, M, Gerber, M, Richardson, S, Segala, C, Gatei, D, Kenya, P, Kungu, A, Mati, JG, Brinton, LA, Hoover, R, Schairer, C, Spirtas, R, Lee, HP, Rookus, MA, van Leeuwen, FE, Schoenberg, JA, Gammon, MD, Clarke, EA, Jones, L, McPherson, K, Neil, A, Vessey, M, Yeates, D, Beral, V, Bull, D, Crossley, B, Hermon, C, Jones, S, Key, T, Lewis, C, Reeves, G, Collins, R, Doll, R, Peto, R, Hannaford, P, Kay, C, Rosero-Bixby, L, Yuan, JM, Wei, HY, Yun, T, Zhiheng, C, Berry, G, Cooper Booth, J, Jelihovsky, T, MacLennan, R, Shearman, R, Wang, QS, Baines, CJ, Miller, AB, Wall, C, Lund, E, Stalsberg, H, Dabancens, A, Martinez, L, Molina, R, Salas, O, Alexander, FE, Hulka, BS, Chilvers, CED, Bernstein, L, Haile, RW, Paganini-Hill, A, Pike, MC, Ross, RK, Ursin, G, Yu, MC, Longnecker, MP, Newcomb, P, Farley, TMN, Holck, S, Meirik, O, Adami, HO, Bergkvist, R, Persson, I, Levi, F, McPherson, K, Mabuchi, K, Preston, D, Katsouyanni, K, Trichopoulou, A, Trichopoulos, D & Bergkvist, L 1997, 'Breast cancer and hormone replacement therapy: Collaborative reanalysis of data from 51 epidemiological studies of 52,705 women with breast cancer and 108,411 women without breast cancer', Lancet, vol. 350, no. 9084, pp. 1047-1059. https://doi.org/10.1016/S0140-6736(97)08233-0
Calle, E. E. ; Heath, C. W. ; Coates, R. J. ; Liff, J. M. ; Franceschi, S. ; Talamini, R. ; Chantarakul, N. ; Koetsawang, S. ; Rachawat, D. ; Morabia, A. ; Schuman, L. ; Stewart, W. ; Szklo, M. ; Bain, C. ; Schofield, F. ; Siskind, V. ; Band, P. ; Coldman, A. J. ; Gallagher, R. P. ; Hislop, T. G. ; Yang, P. ; Duffy, S. W. ; Kolonel, L. M. ; Nomura, A. M Y ; Oberle, M. W. ; Ory, H. W. ; Peterson, H. B. ; Wilson, H. G. ; Wingo, P. A. ; Ebeling, K. ; Kunde, D. ; Nishan, P. ; Colditz, G. ; Martin, N. ; Pardthaisong, T. ; Silpisornkosol, S. ; Theetranont, C. ; Boosiri, B. ; Chutivongse, S. ; Jimakorn, P. ; Virutamasen, P. ; Wongsrichanalai, C. ; McMichael, A. J. ; Rohan, T. ; Ewertz, M. ; Paul, C. ; Skegg, D. C G ; Spears, G. F S ; Boyle, P. ; Evstifeeva, M. ; Daling, J. R. ; Hutchinson, W. B. ; Malone, K. ; Noonan, E. A. ; Stanford, J. L. ; Thomas, D. B. ; Weiss, N. S. ; White, E. ; Andrieu, N. ; Bràmond, A. ; Clavel, F. ; Gairard, B. ; Lansac, J. ; Piana, L. ; Renaud, R. ; Fine, S. R P ; Cuevas, H. R. ; Ontiveros, P. ; Palet, A. ; Salazar, S. B. ; Aristizabel, N. ; Cuadros, A. ; Bachelot, A. ; Lê, M. G. ; Deacon, J. ; Peto, J. ; Taylor, C. N. ; Alfandary, E. ; Modan, B. ; Ron, E. ; Friedman, G. D. ; Hiatt, R. A. ; Bishop, T. ; Kosmelj, J. ; Primic-Zakelj, M. ; Ravnihar, B. ; Stare, J. ; Beeson, W. L. ; Fraser, G. ; Bulbrook, R. D. ; Cuzick, J. ; Fentiman, I. S. ; Hayward, J. L. ; Wang, D. Y. ; Hanson, R. L. ; Leske, M. C. ; Mahoney, M. C. ; Nasca, P. C. ; Varma, A. O. ; Weinstein, A. L. ; Moller, T. R. ; Olsson, H. ; Ranstam, J. ; Goldbohm, R. A. ; van den Brandt, P. A. ; Apelo, R. A. ; Baens, J. ; de la Cruz, J. R. ; Javier, B. ; Lacaya, L. B. ; Ngelangel, C. A. ; La Vecchia, C. ; Negri, E. ; Marubini, E. ; Ferraroni, M. ; Gerber, M. ; Richardson, S. ; Segala, C. ; Gatei, D. ; Kenya, P. ; Kungu, A. ; Mati, J. G. ; Brinton, L. A. ; Hoover, R. ; Schairer, C. ; Spirtas, R. ; Lee, H. P. ; Rookus, M. A. ; van Leeuwen, F. E. ; Schoenberg, J. A. ; Gammon, M. D. ; Clarke, E. A. ; Jones, L. ; McPherson, K. ; Neil, A. ; Vessey, M. ; Yeates, D. ; Beral, V. ; Bull, D. ; Crossley, B. ; Hermon, C. ; Jones, S. ; Key, T. ; Lewis, C. ; Reeves, G. ; Collins, R. ; Doll, R. ; Peto, R. ; Hannaford, P. ; Kay, C. ; Rosero-Bixby, L. ; Yuan, J. M. ; Wei, H. Y. ; Yun, T. ; Zhiheng, C. ; Berry, G. ; Cooper Booth, J. ; Jelihovsky, T. ; MacLennan, R. ; Shearman, R. ; Wang, Q. S. ; Baines, C. J. ; Miller, A. B. ; Wall, C. ; Lund, E. ; Stalsberg, H. ; Dabancens, A. ; Martinez, L. ; Molina, R. ; Salas, O. ; Alexander, F. E. ; Hulka, B. S. ; Chilvers, C. E D ; Bernstein, L. ; Haile, R. W. ; Paganini-Hill, A. ; Pike, M. C. ; Ross, R. K. ; Ursin, G. ; Yu, M. C. ; Longnecker, M. P. ; Newcomb, P. ; Farley, T. M N ; Holck, S. ; Meirik, O. ; Adami, H. O. ; Bergkvist, R. ; Persson, I. ; Levi, F. ; McPherson, K. ; Mabuchi, K. ; Preston, D. ; Katsouyanni, K. ; Trichopoulou, A. ; Trichopoulos, D. ; Bergkvist, L. / Breast cancer and hormone replacement therapy : Collaborative reanalysis of data from 51 epidemiological studies of 52,705 women with breast cancer and 108,411 women without breast cancer. In: Lancet. 1997 ; Vol. 350, No. 9084. pp. 1047-1059.
@article{4e51cd7e757d4532a81fc51fe1a34b35,
title = "Breast cancer and hormone replacement therapy: Collaborative reanalysis of data from 51 epidemiological studies of 52,705 women with breast cancer and 108,411 women without breast cancer",
abstract = "Background. The Collaborative Group on Hormonal Factors in Breast Cancer has brought together and reanalysed about 90{\%} of the worldwide epidemiological evidence on the relation between risk of breast cancer and use of hormone replacement therapy (HRT). Methods. Individual data on 52,705 women with breast cancer and 108,411 women without breast cancer from 51 studies in 21 countries were collected, checked, and analysed centrally. The main analyses are based on 53,865 postmenopausal women with a known age at menopause, of whom 17,830 (33{\%}) had used HRT at some time. The median age at first use was 48 years, and 34{\%} of ever-users had used HRT for 5 years or longer. Estimates of the relative risk of breast cancer associated with the use of HRT were obtained after stratification of all analyses by study, age at diagnosis, time since menopause, body-mass index, parity, and the age a woman was when her first child was born. Findings. Among current users of HRT or those who ceased use 1-4 years previously, the relative risk of having breast cancer diagnosed increased by a factor of 1.023 (95{\%} CI 1.011-1.036; 2p = 0.0002) for each year of use; the relative risk was 1.35 (1.21-1.49; 2p = 0.00001) for women who had used HRT for 5 years or longer (average duration of use in this group 11 years). This increase is comparable with the effect on breast cancer of delaying menopause, since among never-users of HRT the relative risk of breast cancer increases by a factor of 1.028 (95{\%} CI 1.021-1.034) for each year older at menopause. 5 or more years after cessation of HRT use, there was no significant excess of breast cancer overall or in relation to duration of use. These main findings did not vary between individual studies. Of the many factors examined that might affect the relation between breast cancer risk and use of HRT, only a woman's weight and body-mass index had a material effect: the increase in the relative risk of breast dancer associated with long durations of use in current and recent users was greater for women of lower than of higher weight or body-mass index. There was no marked variation in the results according to hormonal type or dose but little information was available about long durations of use of any specific preparation. Cancers diagnosed in women who had ever used HRT tended to be less advanced clinically than those diagnosed in never-users. In North America and Europe the cumulative incidence of breast cancer between the ages of 50 and 70 in never-users of HRT is about 45 per 1000 women. The cumulative excess numbers of breast cancers diagnosed between these ages per 1000 women who began use of HRT at age 50 and used it for 5, 10, and 15 years, respectively, are estimated to be 2 (95{\%} CI 1-3), 6 (3-9), and 12 (5-20). Whether HRT affects mortality from breast cancer is not known. Interpretation. The risk of having breast cancer diagnosed is increased in women using HRT and increases with increasing duration of use. This effect is reduced after cessation of use of HRT and has largely, if not wholly, disappeared after about 5 years. These findings should be considered in the context of the benefits and other risks associated with the use of HRT.",
author = "Calle, {E. E.} and Heath, {C. W.} and Coates, {R. J.} and Liff, {J. M.} and S. Franceschi and R. Talamini and N. Chantarakul and S. Koetsawang and D. Rachawat and A. Morabia and L. Schuman and W. Stewart and M. Szklo and C. Bain and F. Schofield and V. Siskind and P. Band and Coldman, {A. J.} and Gallagher, {R. P.} and Hislop, {T. G.} and P. Yang and Duffy, {S. W.} and Kolonel, {L. M.} and Nomura, {A. M Y} and Oberle, {M. W.} and Ory, {H. W.} and Peterson, {H. B.} and Wilson, {H. G.} and Wingo, {P. A.} and K. Ebeling and D. Kunde and P. Nishan and G. Colditz and N. Martin and T. Pardthaisong and S. Silpisornkosol and C. Theetranont and B. Boosiri and S. Chutivongse and P. Jimakorn and P. Virutamasen and C. Wongsrichanalai and McMichael, {A. J.} and T. Rohan and M. Ewertz and C. Paul and Skegg, {D. C G} and Spears, {G. F S} and P. Boyle and M. Evstifeeva and Daling, {J. R.} and Hutchinson, {W. B.} and K. Malone and Noonan, {E. A.} and Stanford, {J. L.} and Thomas, {D. B.} and Weiss, {N. S.} and E. White and N. Andrieu and A. Br{\`a}mond and F. Clavel and B. Gairard and J. Lansac and L. Piana and R. Renaud and Fine, {S. R P} and Cuevas, {H. R.} and P. Ontiveros and A. Palet and Salazar, {S. B.} and N. Aristizabel and A. Cuadros and A. Bachelot and L{\^e}, {M. G.} and J. Deacon and J. Peto and Taylor, {C. N.} and E. Alfandary and B. Modan and E. Ron and Friedman, {G. D.} and Hiatt, {R. A.} and T. Bishop and J. Kosmelj and M. Primic-Zakelj and B. Ravnihar and J. Stare and Beeson, {W. L.} and G. Fraser and Bulbrook, {R. D.} and J. Cuzick and Fentiman, {I. S.} and Hayward, {J. L.} and Wang, {D. Y.} and Hanson, {R. L.} and Leske, {M. C.} and Mahoney, {M. C.} and Nasca, {P. C.} and Varma, {A. O.} and Weinstein, {A. L.} and Moller, {T. R.} and H. Olsson and J. Ranstam and Goldbohm, {R. A.} and {van den Brandt}, {P. A.} and Apelo, {R. A.} and J. Baens and {de la Cruz}, {J. R.} and B. Javier and Lacaya, {L. B.} and Ngelangel, {C. A.} and {La Vecchia}, C. and E. Negri and E. Marubini and M. Ferraroni and M. Gerber and S. Richardson and C. Segala and D. Gatei and P. Kenya and A. Kungu and Mati, {J. G.} and Brinton, {L. A.} and R. Hoover and C. Schairer and R. Spirtas and Lee, {H. P.} and Rookus, {M. A.} and {van Leeuwen}, {F. E.} and Schoenberg, {J. A.} and Gammon, {M. D.} and Clarke, {E. A.} and L. Jones and K. McPherson and A. Neil and M. Vessey and D. Yeates and V. Beral and D. Bull and B. Crossley and C. Hermon and S. Jones and T. Key and C. Lewis and G. Reeves and R. Collins and R. Doll and R. Peto and P. Hannaford and C. Kay and L. Rosero-Bixby and Yuan, {J. M.} and Wei, {H. Y.} and T. Yun and C. Zhiheng and G. Berry and {Cooper Booth}, J. and T. Jelihovsky and R. MacLennan and R. Shearman and Wang, {Q. S.} and Baines, {C. J.} and Miller, {A. B.} and C. Wall and E. Lund and H. Stalsberg and A. Dabancens and L. Martinez and R. Molina and O. Salas and Alexander, {F. E.} and Hulka, {B. S.} and Chilvers, {C. E D} and L. Bernstein and Haile, {R. W.} and A. Paganini-Hill and Pike, {M. C.} and Ross, {R. K.} and G. Ursin and Yu, {M. C.} and Longnecker, {M. P.} and P. Newcomb and Farley, {T. M N} and S. Holck and O. Meirik and Adami, {H. O.} and R. Bergkvist and I. Persson and F. Levi and K. McPherson and K. Mabuchi and D. Preston and K. Katsouyanni and A. Trichopoulou and D. Trichopoulos and L. Bergkvist",
year = "1997",
month = "10",
day = "11",
doi = "10.1016/S0140-6736(97)08233-0",
language = "English",
volume = "350",
pages = "1047--1059",
journal = "The Lancet",
issn = "0140-6736",
publisher = "Lancet Publishing Group",
number = "9084",

}

TY - JOUR

T1 - Breast cancer and hormone replacement therapy

T2 - Collaborative reanalysis of data from 51 epidemiological studies of 52,705 women with breast cancer and 108,411 women without breast cancer

AU - Calle, E. E.

AU - Heath, C. W.

AU - Coates, R. J.

AU - Liff, J. M.

AU - Franceschi, S.

AU - Talamini, R.

AU - Chantarakul, N.

AU - Koetsawang, S.

AU - Rachawat, D.

AU - Morabia, A.

AU - Schuman, L.

AU - Stewart, W.

AU - Szklo, M.

AU - Bain, C.

AU - Schofield, F.

AU - Siskind, V.

AU - Band, P.

AU - Coldman, A. J.

AU - Gallagher, R. P.

AU - Hislop, T. G.

AU - Yang, P.

AU - Duffy, S. W.

AU - Kolonel, L. M.

AU - Nomura, A. M Y

AU - Oberle, M. W.

AU - Ory, H. W.

AU - Peterson, H. B.

AU - Wilson, H. G.

AU - Wingo, P. A.

AU - Ebeling, K.

AU - Kunde, D.

AU - Nishan, P.

AU - Colditz, G.

AU - Martin, N.

AU - Pardthaisong, T.

AU - Silpisornkosol, S.

AU - Theetranont, C.

AU - Boosiri, B.

AU - Chutivongse, S.

AU - Jimakorn, P.

AU - Virutamasen, P.

AU - Wongsrichanalai, C.

AU - McMichael, A. J.

AU - Rohan, T.

AU - Ewertz, M.

AU - Paul, C.

AU - Skegg, D. C G

AU - Spears, G. F S

AU - Boyle, P.

AU - Evstifeeva, M.

AU - Daling, J. R.

AU - Hutchinson, W. B.

AU - Malone, K.

AU - Noonan, E. A.

AU - Stanford, J. L.

AU - Thomas, D. B.

AU - Weiss, N. S.

AU - White, E.

AU - Andrieu, N.

AU - Bràmond, A.

AU - Clavel, F.

AU - Gairard, B.

AU - Lansac, J.

AU - Piana, L.

AU - Renaud, R.

AU - Fine, S. R P

AU - Cuevas, H. R.

AU - Ontiveros, P.

AU - Palet, A.

AU - Salazar, S. B.

AU - Aristizabel, N.

AU - Cuadros, A.

AU - Bachelot, A.

AU - Lê, M. G.

AU - Deacon, J.

AU - Peto, J.

AU - Taylor, C. N.

AU - Alfandary, E.

AU - Modan, B.

AU - Ron, E.

AU - Friedman, G. D.

AU - Hiatt, R. A.

AU - Bishop, T.

AU - Kosmelj, J.

AU - Primic-Zakelj, M.

AU - Ravnihar, B.

AU - Stare, J.

AU - Beeson, W. L.

AU - Fraser, G.

AU - Bulbrook, R. D.

AU - Cuzick, J.

AU - Fentiman, I. S.

AU - Hayward, J. L.

AU - Wang, D. Y.

AU - Hanson, R. L.

AU - Leske, M. C.

AU - Mahoney, M. C.

AU - Nasca, P. C.

AU - Varma, A. O.

AU - Weinstein, A. L.

AU - Moller, T. R.

AU - Olsson, H.

AU - Ranstam, J.

AU - Goldbohm, R. A.

AU - van den Brandt, P. A.

AU - Apelo, R. A.

AU - Baens, J.

AU - de la Cruz, J. R.

AU - Javier, B.

AU - Lacaya, L. B.

AU - Ngelangel, C. A.

AU - La Vecchia, C.

AU - Negri, E.

AU - Marubini, E.

AU - Ferraroni, M.

AU - Gerber, M.

AU - Richardson, S.

AU - Segala, C.

AU - Gatei, D.

AU - Kenya, P.

AU - Kungu, A.

AU - Mati, J. G.

AU - Brinton, L. A.

AU - Hoover, R.

AU - Schairer, C.

AU - Spirtas, R.

AU - Lee, H. P.

AU - Rookus, M. A.

AU - van Leeuwen, F. E.

AU - Schoenberg, J. A.

AU - Gammon, M. D.

AU - Clarke, E. A.

AU - Jones, L.

AU - McPherson, K.

AU - Neil, A.

AU - Vessey, M.

AU - Yeates, D.

AU - Beral, V.

AU - Bull, D.

AU - Crossley, B.

AU - Hermon, C.

AU - Jones, S.

AU - Key, T.

AU - Lewis, C.

AU - Reeves, G.

AU - Collins, R.

AU - Doll, R.

AU - Peto, R.

AU - Hannaford, P.

AU - Kay, C.

AU - Rosero-Bixby, L.

AU - Yuan, J. M.

AU - Wei, H. Y.

AU - Yun, T.

AU - Zhiheng, C.

AU - Berry, G.

AU - Cooper Booth, J.

AU - Jelihovsky, T.

AU - MacLennan, R.

AU - Shearman, R.

AU - Wang, Q. S.

AU - Baines, C. J.

AU - Miller, A. B.

AU - Wall, C.

AU - Lund, E.

AU - Stalsberg, H.

AU - Dabancens, A.

AU - Martinez, L.

AU - Molina, R.

AU - Salas, O.

AU - Alexander, F. E.

AU - Hulka, B. S.

AU - Chilvers, C. E D

AU - Bernstein, L.

AU - Haile, R. W.

AU - Paganini-Hill, A.

AU - Pike, M. C.

AU - Ross, R. K.

AU - Ursin, G.

AU - Yu, M. C.

AU - Longnecker, M. P.

AU - Newcomb, P.

AU - Farley, T. M N

AU - Holck, S.

AU - Meirik, O.

AU - Adami, H. O.

AU - Bergkvist, R.

AU - Persson, I.

AU - Levi, F.

AU - McPherson, K.

AU - Mabuchi, K.

AU - Preston, D.

AU - Katsouyanni, K.

AU - Trichopoulou, A.

AU - Trichopoulos, D.

AU - Bergkvist, L.

PY - 1997/10/11

Y1 - 1997/10/11

N2 - Background. The Collaborative Group on Hormonal Factors in Breast Cancer has brought together and reanalysed about 90% of the worldwide epidemiological evidence on the relation between risk of breast cancer and use of hormone replacement therapy (HRT). Methods. Individual data on 52,705 women with breast cancer and 108,411 women without breast cancer from 51 studies in 21 countries were collected, checked, and analysed centrally. The main analyses are based on 53,865 postmenopausal women with a known age at menopause, of whom 17,830 (33%) had used HRT at some time. The median age at first use was 48 years, and 34% of ever-users had used HRT for 5 years or longer. Estimates of the relative risk of breast cancer associated with the use of HRT were obtained after stratification of all analyses by study, age at diagnosis, time since menopause, body-mass index, parity, and the age a woman was when her first child was born. Findings. Among current users of HRT or those who ceased use 1-4 years previously, the relative risk of having breast cancer diagnosed increased by a factor of 1.023 (95% CI 1.011-1.036; 2p = 0.0002) for each year of use; the relative risk was 1.35 (1.21-1.49; 2p = 0.00001) for women who had used HRT for 5 years or longer (average duration of use in this group 11 years). This increase is comparable with the effect on breast cancer of delaying menopause, since among never-users of HRT the relative risk of breast cancer increases by a factor of 1.028 (95% CI 1.021-1.034) for each year older at menopause. 5 or more years after cessation of HRT use, there was no significant excess of breast cancer overall or in relation to duration of use. These main findings did not vary between individual studies. Of the many factors examined that might affect the relation between breast cancer risk and use of HRT, only a woman's weight and body-mass index had a material effect: the increase in the relative risk of breast dancer associated with long durations of use in current and recent users was greater for women of lower than of higher weight or body-mass index. There was no marked variation in the results according to hormonal type or dose but little information was available about long durations of use of any specific preparation. Cancers diagnosed in women who had ever used HRT tended to be less advanced clinically than those diagnosed in never-users. In North America and Europe the cumulative incidence of breast cancer between the ages of 50 and 70 in never-users of HRT is about 45 per 1000 women. The cumulative excess numbers of breast cancers diagnosed between these ages per 1000 women who began use of HRT at age 50 and used it for 5, 10, and 15 years, respectively, are estimated to be 2 (95% CI 1-3), 6 (3-9), and 12 (5-20). Whether HRT affects mortality from breast cancer is not known. Interpretation. The risk of having breast cancer diagnosed is increased in women using HRT and increases with increasing duration of use. This effect is reduced after cessation of use of HRT and has largely, if not wholly, disappeared after about 5 years. These findings should be considered in the context of the benefits and other risks associated with the use of HRT.

AB - Background. The Collaborative Group on Hormonal Factors in Breast Cancer has brought together and reanalysed about 90% of the worldwide epidemiological evidence on the relation between risk of breast cancer and use of hormone replacement therapy (HRT). Methods. Individual data on 52,705 women with breast cancer and 108,411 women without breast cancer from 51 studies in 21 countries were collected, checked, and analysed centrally. The main analyses are based on 53,865 postmenopausal women with a known age at menopause, of whom 17,830 (33%) had used HRT at some time. The median age at first use was 48 years, and 34% of ever-users had used HRT for 5 years or longer. Estimates of the relative risk of breast cancer associated with the use of HRT were obtained after stratification of all analyses by study, age at diagnosis, time since menopause, body-mass index, parity, and the age a woman was when her first child was born. Findings. Among current users of HRT or those who ceased use 1-4 years previously, the relative risk of having breast cancer diagnosed increased by a factor of 1.023 (95% CI 1.011-1.036; 2p = 0.0002) for each year of use; the relative risk was 1.35 (1.21-1.49; 2p = 0.00001) for women who had used HRT for 5 years or longer (average duration of use in this group 11 years). This increase is comparable with the effect on breast cancer of delaying menopause, since among never-users of HRT the relative risk of breast cancer increases by a factor of 1.028 (95% CI 1.021-1.034) for each year older at menopause. 5 or more years after cessation of HRT use, there was no significant excess of breast cancer overall or in relation to duration of use. These main findings did not vary between individual studies. Of the many factors examined that might affect the relation between breast cancer risk and use of HRT, only a woman's weight and body-mass index had a material effect: the increase in the relative risk of breast dancer associated with long durations of use in current and recent users was greater for women of lower than of higher weight or body-mass index. There was no marked variation in the results according to hormonal type or dose but little information was available about long durations of use of any specific preparation. Cancers diagnosed in women who had ever used HRT tended to be less advanced clinically than those diagnosed in never-users. In North America and Europe the cumulative incidence of breast cancer between the ages of 50 and 70 in never-users of HRT is about 45 per 1000 women. The cumulative excess numbers of breast cancers diagnosed between these ages per 1000 women who began use of HRT at age 50 and used it for 5, 10, and 15 years, respectively, are estimated to be 2 (95% CI 1-3), 6 (3-9), and 12 (5-20). Whether HRT affects mortality from breast cancer is not known. Interpretation. The risk of having breast cancer diagnosed is increased in women using HRT and increases with increasing duration of use. This effect is reduced after cessation of use of HRT and has largely, if not wholly, disappeared after about 5 years. These findings should be considered in the context of the benefits and other risks associated with the use of HRT.

UR - http://www.scopus.com/inward/record.url?scp=0030843969&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0030843969&partnerID=8YFLogxK

U2 - 10.1016/S0140-6736(97)08233-0

DO - 10.1016/S0140-6736(97)08233-0

M3 - Article

VL - 350

SP - 1047

EP - 1059

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 9084

ER -