Hormones and Breast Cancer

Summary: Estrogen replacement hormones cause breast cancer

Interestingness: 2

Paper by Graham A Colditz, MD, Dr.Ph, FAFPHM in the Journal of Anti-Aging Medicine, Volume 1, Issue 4, Winter 1998.

(((This paper is a subset of the previous one, with a few more details. This summary is going to be very short)))

Higher levels of estrogens in postmenopausal women are associated with higher incidence of breast cancer and lower breast cancer survival. In a smallish study, 130 women, risk of breast cancer was 3.2 (1.4-7.0) times higher among postmenopausal women in the highest quartile of estrogen levels compared with those in the lowest. Other studies give similar results. Yet other studies suggest that risk of breast cancer is associated linearly with accumulated cell divisions in breast epithelial cells.

Since women with the lowest levels of postmenopausal estrogen are more likely to get hormone replacement therapy (HRT), the effect of HRT on breast cancer will be partially hidden if not correcting for this factor. Also, because lower age of menopause is associated with a much lower risk of breast cancer, women on HRT have a lower risk of breast cancer than non-users of the same age (((that only makes sense to me if the non-user hasn't undergone menopause, or is it that the effect of later menopause enough to override total accumulated effect of HRT of all practical time spans?))). A large meta-analysis, of a total of 50000 breast cancer cases and 100000 non-breast cancer cases, estimates risk of breast cancer increases 2.3% (1.1-3.6) per year on HRT. Most studies in the meta-analysis were only using estrogens (((but other parts of the paper claim that progestins wouldn't help and might worsen the risk))). From the meta-analysis, they estimated that for every 1000 postmenopausal women who start HRT at 50, six more will get breast cancer if they use it for ten years, and 12 more if they use it for 15.

(((Summary: again, not particularly influential in life expectancy. Also, I think I remember some big study that came up in the last couple of years, maybe 2008, that most likely supercedes anything in the last couple of posts. This is the main reason I gave both these papers a low interestingness rating. The CHD benefits, if I remember correctly, turned out not to be real)))


Abstract follows:

The role of estrogen replacement therapy in the cause of breast cancer continues to be debated. This article reviews the literature on hormones and breast cancer, including articles on cell proliferation, endogenous hormone levels, epidemiologic studies, and the risk of breast cancer. A cause of cancer is defined as a factor that increases the probability that cancer will develop in an individual. A causal relationship between female hormones and breast cancer is consistently suggested by several lines of argument, especially the relationship between duration of use and risk of breast cancer, dose-response with endogenous hormone levels, and biologic plausibility. The magnitude of the increase in risk of breast cancer caused by using hormone replacement is comparable to that seen in delayed menopause. The positive correlation between endogenous hormone levels and risk of breast cancer supports a causal relationship between exogenous hormone use and breast cancer. The increase in risk of breast cancer with increasing duration of use, which does not vary substantially across studies, offers further evidence for a causal relationship. The reduction in mortality rate with short-term use of hormones, although strongest among women with risk factors for cardiovascular disease, adds complexity to the risk-to-benefit trade-off associated with long-term hormone use. All evidence supports a causal relationship between both endogenous estrogens and the use of estrogens and progestins, and breast cancer incidence in postmenopausal women. Hormones act to promote the late stages of carcinogenesis among postmenopausal women and to facilitate proliferation of malignant cells. Strategies for relief of menopausal symptoms and long-term prevention of osteoporosis and heart disease that do not cause breast cancer are urgently needed.