Abstract
This study investigated how a history of menopausal hormone therapy (MHT) impacts clinical outcomes overall and in different subgroups of breast cancer patients. The study included 814 primary breast cancer patients aged ≥50 years in Sweden (2002–2012) with follow-up until 2016. Associations between patient- and tumor characteristics, recurrences, and overall survival were analyzed in relation to MHT. After a median follow-up of 7 years, 119 recurrences, and 111 deaths occurred. Ever MHT (n = 433, 53.2%) was associated with a lower BMI, frequency of alcohol abstinence, and histological grade, higher frequency of oral contraceptive use, and lobular cancer. Overall, MHT was not associated with prognosis, but there were significant effect modifications by estrogen receptor (ER) status, node status, main histological type, and aromatase inhibitor (AI) treatment on recurrence-risk (all Pinteractions≤ 0.017). MHT conferred an increased recurrence-risk in patients with ER- tumors, adjusted Hazard Ratio (HRadj) 3.99 (95% Confidence Interval (CI) 1.40–11.33), in node-negative patients HRadj 1.88 (95% CI 1.11–3.17), and in non-AI-treated patients HRadj 1.81 (95% CI 1.01–3.24), but decreased recurrence-risk in AI-treated patients HRadj 0.46 (95% CI 0.25–0.84) and in patients with lobular cancer HRadj 0.15 (95% CI 0.04–0.64). MHT was associated with lower risk of death in node-positive patients HRadj of 0.48 (95% CI 0.27–0.86) and in AI-treated patients HRadj of 0.41 (95% CI 0.22–0.77), but not in other patients (both Pinteractions≤ 0.027). A history of MHT may have prognostic value for certain subgroups of breast cancer patients such as AI-treated or node-negative patients.
Highlights
Breast cancer is the most common cancer among women in Sweden and globally and the second most common cause of cancer death among women in Sweden [1]
A previous study using the same cohort as this study showed that the patients included are similar to all breast cancer patients operated at Lund University Hospital during the same period [31]
The difference in overall survival (OS) in the crude model might be explained by differences in patient and tumor characteristics
Summary
Breast cancer is the most common cancer among women in Sweden and globally and the second most common cause of cancer death among women in Sweden [1]. Patients are advised to discontinue MHT use at the time of a breast cancer diagnosis. That study showed that use of combined estrogen and progestin MHT, was associated with an increased risk of coronary heart disease and breast cancer [10]. Two large Swedish studies published shortly thereafter showed similar results with respect to the increased risk of breast cancer with use of combined MHT [4, 11]. After these results gained media attention, the MHT use markedly decreased [8]. Several other studies have reported that MHT increases the risk of breast cancer in women [3, 5, 6, 12,13,14,15], when used for more than 4 years [2, 16]
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