Skip to main content
NCBI home page
British Journal of Cancer logoLink to British Journal of Cancer
. 2001 Sep;85(5):674–677. doi: 10.1054/bjoc.2001.1899

A population-based cohort study of HRT use and breast cancer in southern Sweden

H Olsson 1,2, A Bladström 2, C Ingvar 3, T R Möller 2
PMCID: PMC2364137  PMID: 11531250

Abstract

The overall tumour incidence and breast cancer incidence related to hormone replacement therapy (HRT) were followed in a population-based cohort of 29 508 women, aged 25–65 when interviewed in 1990–92. By the end of the follow up in December 1999, there were 226 611 person-years of observation. A total of 1145 malignant tumours were recorded (expected 1166.6; SIR = 0.98, 95% CI 0.93–1.04). There was a small excess of breast cancer with 434 observed and 387.69 expected (SIR = 1.12, 95% CI 1.02–1.23). Among about 3 663 ever users of HRT, there was no increase in overall tumour incidence (SIR = 0.98, 95% CI 0.86–1.12) but a significant excess of breast cancer (SIR = 1.35, 95% CI 1.09–1.64) compared with never users (SIR = 1.07, 95% CI 0.96–1.19). Breast cancer increased with increasing duration of use and for 48–120 months use the SIR was 1.92 (95% CI 1.32–2.70). There was no significant interaction with family history of breast cancer although an independent additive effect was suggested between HRT use and family history. In a Cox regression model time to breast cancer in relation to duration of HRT use was analysed adjusting for age at menarche, age at menopause, age at first full term pregnancy, parity and age at diagnosis. A significantly higher risk was seen for longer duration of HRT use compared with never users. No increased risk is seen in women beyond 5 years after stopping HRT. There was no interaction between previous use of oral contraceptives and later HRT use. © 2001 Cancer Research Campaign http://www.bjcancer.com

Keywords: hormone replacement therapy, tumour incidence, family history, present use, past use

Full Text

The Full Text of this article is available as a PDF (46.4 KB).

Selected References

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

  1. 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]
  2. Colditz G. A., Hankinson S. E., Hunter D. J., Willett W. C., Manson J. E., Stampfer M. J., Hennekens C., Rosner B., Speizer F. E. The use of estrogens and progestins and the risk of breast cancer in postmenopausal women. N Engl J Med. 1995 Jun 15;332(24):1589–1593. doi: 10.1056/NEJM199506153322401. [DOI] [PubMed] [Google Scholar]
  3. Genazzani A. R., Gambacciani M. Hormone replacement therapy: the perspectives for the 21st century. Maturitas. 1999 May 31;32(1):11–17. doi: 10.1016/s0378-5122(98)00109-1. [DOI] [PubMed] [Google Scholar]
  4. Holli K., Isola J., Cuzick J. Low biologic aggressiveness in breast cancer in women using hormone replacement therapy. J Clin Oncol. 1998 Sep;16(9):3115–3120. doi: 10.1200/JCO.1998.16.9.3115. [DOI] [PubMed] [Google Scholar]
  5. 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]
  6. Jernström H., Frenander J., Fernö M., Olsson H. Hormone replacement therapy before breast cancer diagnosis significantly reduces the overall death rate compared with never-use among 984 breast cancer patients. Br J Cancer. 1999 Jul;80(9):1453–1458. doi: 10.1038/sj.bjc.6690543. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Kelsey J. L., Whittemore A. S. Epidemiology and primary prevention of cancers of the breast, endometrium, and ovary. A brief overview. Ann Epidemiol. 1994 Mar;4(2):89–95. doi: 10.1016/1047-2797(94)90052-3. [DOI] [PubMed] [Google Scholar]
  8. Lando J. F., Heck K. E., Brett K. M. Hormone replacement therapy and breast cancer risk in a nationally representative cohort. Am J Prev Med. 1999 Oct;17(3):176–180. doi: 10.1016/s0749-3797(99)00078-1. [DOI] [PubMed] [Google Scholar]
  9. Li C. I., Anderson B. O., Porter P., Holt S. K., Daling J. R., Moe R. E. Changing incidence rate of invasive lobular breast carcinoma among older women. Cancer. 2000 Jun 1;88(11):2561–2569. [PubMed] [Google Scholar]
  10. Li C. I., Weiss N. S., Stanford J. L., Daling J. R. Hormone replacement therapy in relation to risk of lobular and ductal breast carcinoma in middle-aged women. Cancer. 2000 Jun 1;88(11):2570–2577. doi: 10.1002/1097-0142(20000601)88:11<2570::aid-cncr20>3.0.co;2-o. [DOI] [PubMed] [Google Scholar]
  11. Magnusson C., Baron J. A., Correia N., Bergström R., Adami H. O., Persson I. Breast-cancer risk following long-term oestrogen- and oestrogen-progestin-replacement therapy. Int J Cancer. 1999 May 5;81(3):339–344. doi: 10.1002/(sici)1097-0215(19990505)81:3<339::aid-ijc5>3.0.co;2-6. [DOI] [PubMed] [Google Scholar]
  12. 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]
  13. Mills P. K., Beeson W. L., Phillips R. L., Fraser G. E. Prospective study of exogenous hormone use and breast cancer in Seventh-day Adventists. Cancer. 1989 Aug 1;64(3):591–597. doi: 10.1002/1097-0142(19890801)64:3<591::aid-cncr2820640305>3.0.co;2-u. [DOI] [PubMed] [Google Scholar]
  14. O'Connor I. F., Shembekar M. V., Shousha S. Breast carcinoma developing in patients on hormone replacement therapy: a histological and immunohistological study. J Clin Pathol. 1998 Dec;51(12):935–938. doi: 10.1136/jcp.51.12.935. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. 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]
  16. Persson I. Cancer risk in women receiving estrogen-progestin replacement therapy. Maturitas. 1996 May;23 (Suppl):S37–S45. doi: 10.1016/0378-5122(96)01010-9. [DOI] [PubMed] [Google Scholar]
  17. Pike M. C., Ross R. K. Progestins and menopause: epidemiological studies of risks of endometrial and breast cancer. Steroids. 2000 Oct-Nov;65(10-11):659–664. doi: 10.1016/s0039-128x(00)00122-7. [DOI] [PubMed] [Google Scholar]
  18. Risch H. A., Howe G. R. Menopausal hormone usage and breast cancer in Saskatchewan: a record-linkage cohort study. Am J Epidemiol. 1994 Apr 1;139(7):670–683. doi: 10.1093/oxfordjournals.aje.a117057. [DOI] [PubMed] [Google Scholar]
  19. Ross R. K., Paganini-Hill A., Wan P. C., Pike M. C. Effect of hormone replacement therapy on breast cancer risk: estrogen versus estrogen plus progestin. J Natl Cancer Inst. 2000 Feb 16;92(4):328–332. doi: 10.1093/jnci/92.4.328. [DOI] [PubMed] [Google Scholar]
  20. Schairer C., Gail M., Byrne C., Rosenberg P. S., Sturgeon S. R., Brinton L. A., Hoover R. N. Estrogen replacement therapy and breast cancer survival in a large screening study. J Natl Cancer Inst. 1999 Feb 3;91(3):264–270. doi: 10.1093/jnci/91.3.264. [DOI] [PubMed] [Google Scholar]
  21. Schairer C., Lubin J., Troisi R., Sturgeon S., Brinton L., Hoover R. Menopausal estrogen and estrogen-progestin replacement therapy and breast cancer risk. JAMA. 2000 Jan 26;283(4):485–491. doi: 10.1001/jama.283.4.485. [DOI] [PubMed] [Google Scholar]
  22. Torgerson D. J., Reid D. M. The pharmacoeconomics of hormone replacement therapy. Pharmacoeconomics. 1999 Jul;16(1):9–16. doi: 10.2165/00019053-199916010-00002. [DOI] [PubMed] [Google Scholar]

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

RESOURCES