Breast cancer risk in relation to different types of hormone replacement therapy in the E3N-EPIC cohort

Agnès Fournier, Franco Berrino, Elio Riboli, Valérie Avenel, Françoise Clavel-Chapelon

Research output: Contribution to journalArticle

285 Citations (Scopus)

Abstract

Most epidemiological studies have shown an increase in breast cancer risk related to hormone replacement therapy (HRT) use. A recent large cohort study showed effects of similar magnitude for different types of progestogens and for different routes of administration of estrogens evaluated. Further investigation of these issues is of importance. We assessed the risk of breast cancer associated with HRT use in 54,548 postmenopausal women who had never taken any HRT I year before entering the E3N-EPIC cohort study (mean age at inclusion: 52.8 years); 948 primary invasive breast cancers were diagnosed during follow-up (mean duration: 5.8 years). Data were analyzed using multivariate Cox proportional hazards models. In this cohort where the mean duration of HRT use was 2.8 years, an increased risk in HMT users compared to nonusers was found (relative risk (RR) 1.2 [95% confidence interval 1.1-1.4]). The RR was 1.1 [0.8-1.6] for estrogens used alone and 1.3 [1.1-1.5] when used in combination with oral progestogens. The risk was significantly greater (p <0.001) with HRT containing synthetic progestins than with HRT containing micronized progesterone, the RRs being 1.4 [1.2-1.7] and 0.9 [0.7-1.2], respectively. When combined with synthetic progestins, both oral and transdermal/percutaneous estrogens use were associated with a significantly increased risk; for transdermal/percutaneous estrogens, this was the case even when exposure was less than 2 years. Our results suggest that, when combined with synthetic progestins, even short-term use of estrogens may increase breast cancer risk. Micronized progesterone may be preferred to synthetic progestins in short-term HRT. This finding needs further investigation.

Original languageEnglish
Pages (from-to)448-454
Number of pages7
JournalInternational Journal of Cancer
Volume114
Issue number3
DOIs
Publication statusPublished - Apr 10 2005

Fingerprint

Hormone Replacement Therapy
Progesterone Congeners
Breast Neoplasms
Estrogens
Progestins
Progesterone
Cohort Studies
Proportional Hazards Models
Epidemiologic Studies
Confidence Intervals

Keywords

  • Breast cancer
  • Cohort study
  • Estrogens
  • Hormone replacement therapy
  • Menopause
  • Progesterone
  • Progestogens
  • Risk factors

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Breast cancer risk in relation to different types of hormone replacement therapy in the E3N-EPIC cohort. / Fournier, Agnès; Berrino, Franco; Riboli, Elio; Avenel, Valérie; Clavel-Chapelon, Françoise.

In: International Journal of Cancer, Vol. 114, No. 3, 10.04.2005, p. 448-454.

Research output: Contribution to journalArticle

Fournier, Agnès ; Berrino, Franco ; Riboli, Elio ; Avenel, Valérie ; Clavel-Chapelon, Françoise. / Breast cancer risk in relation to different types of hormone replacement therapy in the E3N-EPIC cohort. In: International Journal of Cancer. 2005 ; Vol. 114, No. 3. pp. 448-454.
@article{a3c26f729d454ac9be13dbf09d5a90bd,
title = "Breast cancer risk in relation to different types of hormone replacement therapy in the E3N-EPIC cohort",
abstract = "Most epidemiological studies have shown an increase in breast cancer risk related to hormone replacement therapy (HRT) use. A recent large cohort study showed effects of similar magnitude for different types of progestogens and for different routes of administration of estrogens evaluated. Further investigation of these issues is of importance. We assessed the risk of breast cancer associated with HRT use in 54,548 postmenopausal women who had never taken any HRT I year before entering the E3N-EPIC cohort study (mean age at inclusion: 52.8 years); 948 primary invasive breast cancers were diagnosed during follow-up (mean duration: 5.8 years). Data were analyzed using multivariate Cox proportional hazards models. In this cohort where the mean duration of HRT use was 2.8 years, an increased risk in HMT users compared to nonusers was found (relative risk (RR) 1.2 [95{\%} confidence interval 1.1-1.4]). The RR was 1.1 [0.8-1.6] for estrogens used alone and 1.3 [1.1-1.5] when used in combination with oral progestogens. The risk was significantly greater (p <0.001) with HRT containing synthetic progestins than with HRT containing micronized progesterone, the RRs being 1.4 [1.2-1.7] and 0.9 [0.7-1.2], respectively. When combined with synthetic progestins, both oral and transdermal/percutaneous estrogens use were associated with a significantly increased risk; for transdermal/percutaneous estrogens, this was the case even when exposure was less than 2 years. Our results suggest that, when combined with synthetic progestins, even short-term use of estrogens may increase breast cancer risk. Micronized progesterone may be preferred to synthetic progestins in short-term HRT. This finding needs further investigation.",
keywords = "Breast cancer, Cohort study, Estrogens, Hormone replacement therapy, Menopause, Progesterone, Progestogens, Risk factors",
author = "Agn{\`e}s Fournier and Franco Berrino and Elio Riboli and Val{\'e}rie Avenel and Fran{\cc}oise Clavel-Chapelon",
year = "2005",
month = "4",
day = "10",
doi = "10.1002/ijc.20710",
language = "English",
volume = "114",
pages = "448--454",
journal = "International Journal of Cancer",
issn = "0020-7136",
publisher = "Wiley-Liss Inc.",
number = "3",

}

TY - JOUR

T1 - Breast cancer risk in relation to different types of hormone replacement therapy in the E3N-EPIC cohort

AU - Fournier, Agnès

AU - Berrino, Franco

AU - Riboli, Elio

AU - Avenel, Valérie

AU - Clavel-Chapelon, Françoise

PY - 2005/4/10

Y1 - 2005/4/10

N2 - Most epidemiological studies have shown an increase in breast cancer risk related to hormone replacement therapy (HRT) use. A recent large cohort study showed effects of similar magnitude for different types of progestogens and for different routes of administration of estrogens evaluated. Further investigation of these issues is of importance. We assessed the risk of breast cancer associated with HRT use in 54,548 postmenopausal women who had never taken any HRT I year before entering the E3N-EPIC cohort study (mean age at inclusion: 52.8 years); 948 primary invasive breast cancers were diagnosed during follow-up (mean duration: 5.8 years). Data were analyzed using multivariate Cox proportional hazards models. In this cohort where the mean duration of HRT use was 2.8 years, an increased risk in HMT users compared to nonusers was found (relative risk (RR) 1.2 [95% confidence interval 1.1-1.4]). The RR was 1.1 [0.8-1.6] for estrogens used alone and 1.3 [1.1-1.5] when used in combination with oral progestogens. The risk was significantly greater (p <0.001) with HRT containing synthetic progestins than with HRT containing micronized progesterone, the RRs being 1.4 [1.2-1.7] and 0.9 [0.7-1.2], respectively. When combined with synthetic progestins, both oral and transdermal/percutaneous estrogens use were associated with a significantly increased risk; for transdermal/percutaneous estrogens, this was the case even when exposure was less than 2 years. Our results suggest that, when combined with synthetic progestins, even short-term use of estrogens may increase breast cancer risk. Micronized progesterone may be preferred to synthetic progestins in short-term HRT. This finding needs further investigation.

AB - Most epidemiological studies have shown an increase in breast cancer risk related to hormone replacement therapy (HRT) use. A recent large cohort study showed effects of similar magnitude for different types of progestogens and for different routes of administration of estrogens evaluated. Further investigation of these issues is of importance. We assessed the risk of breast cancer associated with HRT use in 54,548 postmenopausal women who had never taken any HRT I year before entering the E3N-EPIC cohort study (mean age at inclusion: 52.8 years); 948 primary invasive breast cancers were diagnosed during follow-up (mean duration: 5.8 years). Data were analyzed using multivariate Cox proportional hazards models. In this cohort where the mean duration of HRT use was 2.8 years, an increased risk in HMT users compared to nonusers was found (relative risk (RR) 1.2 [95% confidence interval 1.1-1.4]). The RR was 1.1 [0.8-1.6] for estrogens used alone and 1.3 [1.1-1.5] when used in combination with oral progestogens. The risk was significantly greater (p <0.001) with HRT containing synthetic progestins than with HRT containing micronized progesterone, the RRs being 1.4 [1.2-1.7] and 0.9 [0.7-1.2], respectively. When combined with synthetic progestins, both oral and transdermal/percutaneous estrogens use were associated with a significantly increased risk; for transdermal/percutaneous estrogens, this was the case even when exposure was less than 2 years. Our results suggest that, when combined with synthetic progestins, even short-term use of estrogens may increase breast cancer risk. Micronized progesterone may be preferred to synthetic progestins in short-term HRT. This finding needs further investigation.

KW - Breast cancer

KW - Cohort study

KW - Estrogens

KW - Hormone replacement therapy

KW - Menopause

KW - Progesterone

KW - Progestogens

KW - Risk factors

UR - http://www.scopus.com/inward/record.url?scp=14044266896&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=14044266896&partnerID=8YFLogxK

U2 - 10.1002/ijc.20710

DO - 10.1002/ijc.20710

M3 - Article

C2 - 15551359

AN - SCOPUS:14044266896

VL - 114

SP - 448

EP - 454

JO - International Journal of Cancer

JF - International Journal of Cancer

SN - 0020-7136

IS - 3

ER -