Issn Print: 0029-7828

Publication Date: 2001/10/01


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Hormone Replacement Therapy After a Diagnosis of Breast Cancer in Relation to Recurrence and Mortality

Ellen S. O’Meara; Mary Anne Rossing; Janet R. Daling; Joann G. Elmore; William E. Barlow; Noel S. Weiss

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Hormone Replacement Therapy After a Diagnosis of Breast Cancer in Relation to Recurrence and Mortality Ellen S. O’Meara Mary Anne Rossing Janet R. Daling Joann G. Elmore William E. Barlow and Noel S. Weiss Fred Hutchinson Cancer Research Center and Department of Epidemiology, University of Washington, Seattle; Departments of Epidemiology and General Internal Medicine, University of Washington; Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle; and Department of Biostatistics, University of Washington J Natl Cancer Inst 2001; 93: 754–762
Typically women with a history of breast cancer do not receive hormone replacement therapy (HRT) out of fear that estrogen will stimulate a recurrence. Nevertheless some women do use HRT in this setting. This study sought to determine the effects, if any, of HRT in 2755 women ranging in age from 35 to 74 years who had received a diagnosis of incident invasive breast cancer in the years 1977–1994. Each of the 174 women who had used HRT after diagnosis was matched for age, disease stage, and year of diagnosis with 4 nonusers. All women were free of recurrent disease at the time HRT began or at the equivalent time since diagnosis. Outcomes were analyzed through 1996. Only oral HRT was used by 41% of recipients, only vaginal HRT by 43%, and both types by 16%. The median time of oral HRT use was 15 months. Progestogens were administered to only 21% of HRT recipients.
Recurrent breast cancer was found in 9% of HRT users and 15% of nonusers. The respective recurrence rates were 17 and 30 per 1000 person-years of follow-up. After adjusting for oophorectomy, hysterectomy, mastectomy, and tamoxifen, the relative risk associated with any use of HRT after breast cancer diagnosis was 0.5. A similar risk was found when limiting analysis to women using unopposed estrogen. Breast cancer mortality was 5 per 1000 person-years in HRT users and 15 per 1000 in nonusers; the adjusted relative risk was 0.34. The risk of recurrence in HRT users was especially low in the first year of follow-up. Unadjusted relative risks from HRT use in women whose tumors were estrogen receptor–positive were 0.31 for recurrence and 0.16 for breast cancer death. The respective figures for women with estrogen receptor–negative tumors were 0.81 and 0.56.
The risk of recurrent or fatal breast cancer does not seem to be increased in women who take HRT after diagnosis, but these results must be interpreted cautiously. It would be helpful to conduct randomized trials of HRT in women who are in remission of breast cancer and who have symptoms of estrogen loss.

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