Mortality due to breast cancer in American women is similar to that due to coronary heart disease in the age group 45–59 years old. Because of this, it is of utmost importance to establish the potential impact of hormone therapy (HT) around the time of menopause on breast cancer. Recent analyses of the Women’s Health Initiative (WHI) data suggest that women who initiate HT soon after the menopause have a higher breast cancer risk than those treated some years later. A recently published paper reports on the investigation of this possible relationship in a prospective cohort study in French women, the E3N cohort . The authors studied 53,310 women from a pool of 98,995 women, using self-administered questionnaires sent biennially between 1990 and 2005. All these women were born between 1921 and 1950 and were already postmenopausal. The information on lifetime use of HT, which was recorded in the 1992 questionnaire, included start date, brand names and duration of HT use. ‘Recent use’ was defined as current use or use in the last 12 months. The time elapsed from menopause to treatment initiation was referred as the ‘gap time’.
A total of 1726 breast cancers were diagnosed during 433,647 woman-years of follow-up. The ever-use group had a significantly higher breast cancer risk when compared with never-users, but this was evident only in women with recent use of HT. Past use did not increase the risk (hazard ratios (HR) 1.09 and 1.04 for a gap time ≤ 3 years and for > 3 years of use, respectively). Recent users with a gap time ≤ 3 years had a HR of 1.61 (95% confidence interval (CI) 1.43–1.81); in those with a gap time > 3 years, the HR was 1.36 (95% CI 1.13–1.63). For treatment duration, there was no increase in the risk with short duration (< 2 years) and with a gap time > 3 years. When the gap time was ≤ 3 years, the HR was 1.54 (95% CI 1.28–1.86) except with the combination of estradiol and pure progesterone. In this case, the HRs were 0.87 and 0.90 for a treatment < 2 years and a gap time ≤ 3 years and > 3 years, respectively. However, the breast cancer risk increased after 5 years of estradiol + progesterone. If other progestogens were used for more than 2 years, the HR was in the order of 2, whatever the gap time, but dydrogesterone had an intermediate risk. In conclusion, the authors stressed that, in contrast to coronary disease, there is no ‘window of opportunity’ in regard to breast cancer risk. It appears that there is a tendency for a higher hazard ratio when treatment starts very soon after menopause. The risk is even higher with progesterone when treatment continues for more than 5 years.
Roberto I. Tozzini
Honorary Professor and Past Professor and Chairman in Gynecology, National University of Rosario, Argentina
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