Skip to main content
British Journal of Cancer logoLink to British Journal of Cancer
. 1999 Jul;80(9):1453–1458. doi: 10.1038/sj.bjc.6690543

Hormone replacement therapy before breast cancer diagnosis significantly reduces the overall death rate compared with never-use among 984 breast cancer patients

H Jernström 1, J Frenander 1, M Fernö 1, H Olsson 1
PMCID: PMC2363064  PMID: 10424750

Abstract

Nine hundred and eighty-four breast cancer patients were interviewed regarding exogenous hormonal use. This represents a random sample of breast cancer patients in Southern Sweden referred to the Department of Oncology at Lund for treatment between 1978 and 1997 (excluding 1980 and 1981) with a 100% follow-up. Ever-use of hormone replacement therapy (HRT) prior to diagnosis was significantly associated with a longer overall survival in women with their breast cancer diagnosed at ages 45 and above, relative risk (RR) of dying 0.73 (95% confidence interval (CI) 0.62–0.87; P = 0.0005). Ever use of HRT prior to breast cancer diagnosis was significantly positively associated with overall longer survival after adjustment for T-stage, N-stage, M-stage, year of diagnosis and age at diagnosis, RR of dying 0.78 (95% CI 0.65–0.93; P = 0.006). Hormone replacement therapy use and oestrogen receptor positivity were independently significantly associated with overall longer survival, P = 0.005 and P < 0.0001, respectively, in one model. HRT use and progesterone receptor positivity were also independently significantly associated with longer overall survival, P = 0.003 and P = 0.0003, respectively, in another model. The mode of diagnosis was known in 705 women. Mammography screening was not more common among HRT users compared with never-users, where this information was available. Both mammography screening and HRT use were independently associated with longer survival, P = 0.002 and P = 0.038 respectively. © 1999 Cancer Research Campaign

Keywords: breast cancer, overall survival, HRT, oestrogen receptor, progesterone receptor

Full Text

The Full Text of this article is available as a PDF (79.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bergkvist L., Adami H. O., Persson I., Bergström R., Krusemo U. B. Prognosis after breast cancer diagnosis in women exposed to estrogen and estrogen-progestogen replacement therapy. Am J Epidemiol. 1989 Aug;130(2):221–228. doi: 10.1093/oxfordjournals.aje.a115328. [DOI] [PubMed] [Google Scholar]
  2. Bonnier P., Romain S., Giacalone P. L., Laffargue F., Martin P. M., Piana L. Clinical and biologic prognostic factors in breast cancer diagnosed during postmenopausal hormone replacement therapy. Obstet Gynecol. 1995 Jan;85(1):11–17. doi: 10.1016/0029-7844(94)00324-7. [DOI] [PubMed] [Google Scholar]
  3. Brinton L. A., Hoover R., Fraumeni J. F., Jr Menopausal oestrogens and breast cancer risk: an expanded case-control study. Br J Cancer. 1986 Nov;54(5):825–832. doi: 10.1038/bjc.1986.246. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Fernö M., Borg A., Johansson U. Enzyme immunoassay of progesterone receptor in breast cancer biopsy samples. A comparison with the dextran coated charcoal method. Acta Oncol. 1989;28(1):19–22. doi: 10.3109/02841868909111175. [DOI] [PubMed] [Google Scholar]
  5. Fernö M., Borg A., Norgren A. A comparison of two steroid receptor assays in breast cancer: dextran coated charcoal and isoelectric focusing. Anticancer Res. 1983 Jul-Aug;3(4):243–246. [PubMed] [Google Scholar]
  6. Fernö M., Borg A., Sellberg G. Enzyme immuno assay of the estrogen receptor in breast cancer biopsy samples. A comparison with isoelectric focusing. Acta Radiol Oncol. 1986 May-Jun;25(3):171–175. doi: 10.3109/02841868609136398. [DOI] [PubMed] [Google Scholar]
  7. Grodstein F., Stampfer M. J., Colditz G. A., Willett W. C., Manson J. E., Joffe M., Rosner B., Fuchs C., Hankinson S. E., Hunter D. J. Postmenopausal hormone therapy and mortality. N Engl J Med. 1997 Jun 19;336(25):1769–1775. doi: 10.1056/NEJM199706193362501. [DOI] [PubMed] [Google Scholar]
  8. Harding C., Knox W. F., Faragher E. B., Baildam A., Bundred N. J. Hormone replacement therapy and tumour grade in breast cancer: prospective study in screening unit. BMJ. 1996 Jun 29;312(7047):1646–1647. doi: 10.1136/bmj.312.7047.1646. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Henderson B. E., Paganini-Hill A., Ross R. K. Decreased mortality in users of estrogen replacement therapy. Arch Intern Med. 1991 Jan;151(1):75–78. [PubMed] [Google Scholar]
  10. Hulley S., Grady D., Bush T., Furberg C., Herrington D., Riggs B., Vittinghoff E. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group. JAMA. 1998 Aug 19;280(7):605–613. doi: 10.1001/jama.280.7.605. [DOI] [PubMed] [Google Scholar]
  11. Hunt K., Vessey M., McPherson K. Mortality in a cohort of long-term users of hormone replacement therapy: an updated analysis. Br J Obstet Gynaecol. 1990 Dec;97(12):1080–1086. doi: 10.1111/j.1471-0528.1990.tb02494.x. [DOI] [PubMed] [Google Scholar]
  12. Hunter D. J., Willett W. C. Diet, body size, and breast cancer. Epidemiol Rev. 1993;15(1):110–132. doi: 10.1093/oxfordjournals.epirev.a036096. [DOI] [PubMed] [Google Scholar]
  13. Jones C., Ingram D., Mattes E., Hahnel R. The effect of hormone replacement therapy on prognostic indices in women with breast cancer. Med J Aust. 1994 Jul 18;161(2):106–110. doi: 10.5694/j.1326-5377.1994.tb127340.x. [DOI] [PubMed] [Google Scholar]
  14. Magnusson C., Holmberg L., Nordén T., Lindgren A., Persson I. Prognostic characteristics in breast cancers after hormone replacement therapy. Breast Cancer Res Treat. 1996;38(3):325–334. doi: 10.1007/BF01806152. [DOI] [PubMed] [Google Scholar]
  15. Matthews K. A., Kuller L. H., Wing R. R., Meilahn E. N., Plantinga P. Prior to use of estrogen replacement therapy, are users healthier than nonusers? Am J Epidemiol. 1996 May 15;143(10):971–978. doi: 10.1093/oxfordjournals.aje.a008678. [DOI] [PubMed] [Google Scholar]
  16. Nischan P., Thomas D. B., Ebeling K. Accuracy of recall of use of an intrauterine device. Contraception. 1992 Apr;45(4):363–368. doi: 10.1016/0010-7824(92)90058-2. [DOI] [PubMed] [Google Scholar]
  17. Nyström L., Rutqvist L. E., Wall S., Lindgren A., Lindqvist M., Rydén S., Andersson I., Bjurstam N., Fagerberg G., Frisell J. Breast cancer screening with mammography: overview of Swedish randomised trials. Lancet. 1993 Apr 17;341(8851):973–978. doi: 10.1016/0140-6736(93)91067-v. [DOI] [PubMed] [Google Scholar]
  18. Olsson H., Hägglund G. Reduced cancer morbidity and mortality in a prospective cohort of women with distal forearm fractures. Am J Epidemiol. 1992 Aug 15;136(4):422–427. doi: 10.1093/oxfordjournals.aje.a116515. [DOI] [PubMed] [Google Scholar]
  19. Persson I., Bergkvist L., Lindgren C., Yuen J. Hormone replacement therapy and major risk factors for reproductive cancers, osteoporosis, and cardiovascular diseases: evidence of confounding by exposure characteristics. J Clin Epidemiol. 1997 May;50(5):611–618. doi: 10.1016/s0895-4356(97)00004-8. [DOI] [PubMed] [Google Scholar]
  20. Salmon R. J., Remvikos Y., Ansquer Y., Asselain B. HRT and breast cancer. Lancet. 1995 Dec 23;346(8991-8992):1702–1703. doi: 10.1016/s0140-6736(95)92864-2. [DOI] [PubMed] [Google Scholar]
  21. Schairer C., Byrne C., Keyl P. M., Brinton L. A., Sturgeon S. R., Hoover R. N. Menopausal estrogen and estrogen-progestin replacement therapy and risk of breast cancer (United States). Cancer Causes Control. 1994 Nov;5(6):491–500. doi: 10.1007/BF01831376. [DOI] [PubMed] [Google Scholar]
  22. Sigurdsson H., Baldetorp B., Borg A., Dalberg M., Fernö M., Killander D., Olsson H. Indicators of prognosis in node-negative breast cancer. N Engl J Med. 1990 Apr 12;322(15):1045–1053. doi: 10.1056/NEJM199004123221505. [DOI] [PubMed] [Google Scholar]
  23. Squitieri R., Tartter P. I., Ahmed S., Brower S. T., Theise N. D. Carcinoma of the breast in postmenopausal hormone user and nonuser control groups. J Am Coll Surg. 1994 Feb;178(2):167–170. [PubMed] [Google Scholar]
  24. Strickland D. M., Gambrell R. D., Jr, Butzin C. A., Strickland K. The relationship between breast cancer survival and prior postmenopausal estrogen use. Obstet Gynecol. 1992 Sep;80(3 Pt 1):400–404. [PubMed] [Google Scholar]
  25. Sullivan J. M., Vander Zwaag R., Hughes J. P., Maddock V., Kroetz F. W., Ramanathan K. B., Mirvis D. M. Estrogen replacement and coronary artery disease. Effect on survival in postmenopausal women. Arch Intern Med. 1990 Dec;150(12):2557–2562. [PubMed] [Google Scholar]
  26. Willis D. B., Calle E. E., Miracle-McMahill H. L., Heath C. W., Jr Estrogen replacement therapy and risk of fatal breast cancer in a prospective cohort of postmenopausal women in the United States. Cancer Causes Control. 1996 Jul;7(4):449–457. doi: 10.1007/BF00052671. [DOI] [PubMed] [Google Scholar]
  27. Yuen J., Persson I., Bergkvist L., Hoover R., Schairer C., Adami H. O. Hormone replacement therapy and breast cancer mortality in Swedish women: results after adjustment for 'healthy drug-user' effect. Cancer Causes Control. 1993 Jul;4(4):369–374. doi: 10.1007/BF00051340. [DOI] [PubMed] [Google Scholar]

Articles from British Journal of Cancer are provided here courtesy of Cancer Research UK

RESOURCES