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Breast cancer in menopausal women with hormonal replacement therapy
International Congress Series 1271 (2004) 414 – 416
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Breast cancer in menopausal women with hormonal replacement therapy E. Rosales *, L. Sordia, J. Vazquez, J.L. Iglesias, A. Morales, M. Castan˜eda, O. Vidal, D. Saldivar, M. Merino, M. Garcı´a Universitary Center of Reproductive Medicine UANL, Hospital Universitario, Madero y Gonzalitoz cp, 64460, Monterrey, NL, Mexico
Abstract. A possible relationship between hormonal therapy (HT) and breast cancer has been explored in numerous epidemiological studies. The effect of HT on mortality from breast cancer is unclear. The objective of this study is to determine the relationship between HT and breast cancer, and determine if these tumors are more differentiated and less aggressive in HT users. This is a retrospective, descriptive, cohort study. The study group consisted of 120 patients with breast cancer diagnosed from January 1998 to January 2002. We collect demographic characteristics, reproductive health history, smoking consumption, age at menarche, at first birth, and at menopause, parity, lactation history, use and duration of HT, type of HT, history of benign breast disease, family history of breast cancer, previous diagnosis of contra lateral breast cancer, body mass index, height, use a of oral contraceptives, breast cancer stage and the histological type of carcinoma. The results show a mean age of 49.8 years. Twelve patients (10.1%) used oral contraceptives with duration from 5 to 13 years (mean 9.6 years), 18 patients (15%) received HT with duration from 6 to 18 years (mean 8.5 years), 8 patients (44.4%) received estrogen replacement therapy, 10 patients received regimen of oestrogen – progestagen combination therapy. Seventeen patients HT users (94.4%) was found with stage III A disease, or earlier. The histological type that was found most frequently in HT users was the cancer invasive ductal good differenced, and in the nonuser group HT the histological type that was found most frequently was the adenocarcinoma invasive ductal bad differenced. Three patients used HT after the diagnosis of breast cancer and all of them developed a contra lateral breast cancer. The results of this study confirm previous findings that current and recent use of HT is associated with an increase of incidence of breast cancer. Estrogen replacement therapy apparently increase the risk of recurrence in patients with breast cancer previously diagnosed. In this study we found that tumor differentiation is worst in HT users. D 2004 Elsevier B.V. All rights reserved. Keywords: Breast cancer; Hormonal therapy; Contra lateral breast cancer
* Corresponding author. E-mail address: [email protected] (E. Rosales). 0531-5131/ D 2004 Elsevier B.V. All rights reserved. doi:10.1016/j.ics.2004.05.131
E. Rosales et al. / International Congress Series 1271 (2004) 414–416
415
1. Introduction A possible relationship between HT and breast cancer has been explored in numerous epidemiological studies over the past several decades, with inconsistent results [1,2]. Results from randomized controlled trials and from observational studies show that current and recent use of hormone-replacement therapy (HT) increases the risk of breast cancer [4,5]. However, the effect of HT on mortality from breast cancer is unclear [4,6]. Few estimates of the absolute increase in breast cancer incidence are available for users of oestrogen– progestagen HT. The Women’s Health Initiative Trial found an increased incidence of breast cancer in women who complied with treatment [8], of about six per 1000 women after 5 years use, and 18 per 1000 after 7 years use of oestrogen – progestagen HT; similar to results from the Million Women Study, based on substantially larger numbers, of an increase in the cumulative incidence of six [2,3] per 1000 for 10 years’ use of oestrogen – progestagen HT. In HT users tumors have been described to be more differentiated, small, and less aggressive with a major survival [9,10]. The frequency of breast cancer increases throughout the life span of women. However, there is no direct evidence to indicate that female hormones worsen the prognosis of this malignancy [11]. This is a retrospective, descriptive and cohort study that intends to determine the relationship between breast cancer and HT and its the relation with the histological findings. 2. Material and methods The study group consisted of 120 patients with breast cancer diagnosed and attended at Obstetrics and Gynecology service of Universitary Hospital ‘‘Dr Jose´ Eleuterio Gonza´lez’’ from January 1998 to January 2002. Date were collected at baseline on demographic characteristics, reproductive health history, smoking consumption, age at menarche, first birth, and menopause, parity, use and duration of HT, type of HT, history of benign breast disease, family history of breast cancer, previous diagnosis of contra lateral breast cancer, body mass index, height, history of lactation, use and durations of oral contraceptives, breast cancer stage and the histological type of carcinoma. 3. Results The study group consisted of 120 patients who ranged in age from 22 to 80 years (mean age from 49.8 years), body mass index from 20.8 to 42.8 (mean 29.7). The risk factor included. Age at menarche from 9 to 15 years (mean age 12 years), age at menopause from 0 to 56 years (mean 52 years), no lactation history was found in 40 patients (33.3%), nulliparous women was found in 28 patients (23.3%). The mean age first birth 24 years, history smoking consumption was found in 45 patients (37.5%) in the nonuser group HT and (38.8%) in the HT group. Twelve patients (10.1%) used oral contraceptives with duration from 5 to 13 years (mean 9.6 years), 18 patients (15%) who received HT with duration from 6 to 18 years (mean 8.5 years), 8 patients (44.4%) who received estrogen replacement therapy, 10 patients (55.6%) who received regimen of oestrogen– progestagen combination therapy. Seventeen patients HT users (94.4%) was found with stage III A disease, or earlier. The histological type that was most frequently
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E. Rosales et al. / International Congress Series 1271 (2004) 414–416
found in HT users was the well differenced invasive ductal cancer, and in the HT nonuser group the histological type that was most frequently found was the bad differenced invasive ductal adenocarcinoma. 4. Conclusions The results of this study confirm previous findings that current and recent use of HT is associated with an increase of the incidence of breast cancer [4,7]. The age at the diagnosis of breast cancer in our population was an average of 49.8%, but is remarkable that 40% of our patients has 40 years or less at diagnosis time. Contrary to previous reports, our findings showed the stage at diagnosis time was III, this do not agree with the idea than HT users have earliest stages at diagnosis time, but in this study we also found that in HT users this tumors were better differentiated than in HT nonusers. The present study found HT apparently increases the risk of recurrence of breast cancer in the contra lateral breast in patients previously diagnosed with breast cancer [11]. References [1] C. Finley, et al., Disparities in hormone replacement therapy use by socioeconomic status in a primary care population, J. Commun. Health 26 (2001) 39 – 50. [2] C.L. Chen, et al., Hormone replacement therapy in relation to breast cancer, JAMA 287 (2002) 734 – 741. [3] K.H. Humphries, et al., Risks and benefits of hormone replacement therapy: the evidence speaks, Can. Med. Assoc. J. 168 (8) (2003) 1001 – 1010. [4] Collaborative Group on Hormonal Factors in Breast Cancer, Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52705 women with breast cancer and 108411 women without breast cancer, Lancet 350 (1997) 1047 – 1059. [5] V. Beral, E. Banks, G. Reeves, Evidence from randomized trials on the long-term effects of hormone replacement therapy, Lancet 360 (2002) 942 – 944. [6] V. Beral, et al., Use of HRT and the subsequent risk of cancer, J. Epidemiol. Biostat. 4 (1999) 191 – 215. [7] Cl. Li, et al., Relationship between long durations and different regimens of hormone therapy and risk of breast cancer, JAMA 289 (2003) 3254 – 3263. [8] R.T. Chlebowski, et al., Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women’s Health Initiative randomized trial, JAMA 289 (2003) 3243 – 3253. [9] S.M. Gapstur, M. Morrow, T.A. Selters, Hormone replacement therapy and risk of breast cancer with a favorable histology: results of the Iowa Women’s Health Study, JAMA 281 (1999) 2091 – 2097. [10] C. Schairer, et al., Estrogen replacement therapy and breast cancer survival in a large screening study, J. Natl. Cancer Inst. 91 (1999) 264 – 270. [11] K. Puthugramam, R. Natrajan, R. Don Gambrell, Estrogen replacement therapy in patients with early breast cancer, Am. J. Obstet. Gynecol. 187 (2002) 289 – 295.
www.ics-elsevier.com
Breast cancer in menopausal women with hormonal replacement therapy E. Rosales *, L. Sordia, J. Vazquez, J.L. Iglesias, A. Morales, M. Castan˜eda, O. Vidal, D. Saldivar, M. Merino, M. Garcı´a Universitary Center of Reproductive Medicine UANL, Hospital Universitario, Madero y Gonzalitoz cp, 64460, Monterrey, NL, Mexico
Abstract. A possible relationship between hormonal therapy (HT) and breast cancer has been explored in numerous epidemiological studies. The effect of HT on mortality from breast cancer is unclear. The objective of this study is to determine the relationship between HT and breast cancer, and determine if these tumors are more differentiated and less aggressive in HT users. This is a retrospective, descriptive, cohort study. The study group consisted of 120 patients with breast cancer diagnosed from January 1998 to January 2002. We collect demographic characteristics, reproductive health history, smoking consumption, age at menarche, at first birth, and at menopause, parity, lactation history, use and duration of HT, type of HT, history of benign breast disease, family history of breast cancer, previous diagnosis of contra lateral breast cancer, body mass index, height, use a of oral contraceptives, breast cancer stage and the histological type of carcinoma. The results show a mean age of 49.8 years. Twelve patients (10.1%) used oral contraceptives with duration from 5 to 13 years (mean 9.6 years), 18 patients (15%) received HT with duration from 6 to 18 years (mean 8.5 years), 8 patients (44.4%) received estrogen replacement therapy, 10 patients received regimen of oestrogen – progestagen combination therapy. Seventeen patients HT users (94.4%) was found with stage III A disease, or earlier. The histological type that was found most frequently in HT users was the cancer invasive ductal good differenced, and in the nonuser group HT the histological type that was found most frequently was the adenocarcinoma invasive ductal bad differenced. Three patients used HT after the diagnosis of breast cancer and all of them developed a contra lateral breast cancer. The results of this study confirm previous findings that current and recent use of HT is associated with an increase of incidence of breast cancer. Estrogen replacement therapy apparently increase the risk of recurrence in patients with breast cancer previously diagnosed. In this study we found that tumor differentiation is worst in HT users. D 2004 Elsevier B.V. All rights reserved. Keywords: Breast cancer; Hormonal therapy; Contra lateral breast cancer
* Corresponding author. E-mail address: [email protected] (E. Rosales). 0531-5131/ D 2004 Elsevier B.V. All rights reserved. doi:10.1016/j.ics.2004.05.131
E. Rosales et al. / International Congress Series 1271 (2004) 414–416
415
1. Introduction A possible relationship between HT and breast cancer has been explored in numerous epidemiological studies over the past several decades, with inconsistent results [1,2]. Results from randomized controlled trials and from observational studies show that current and recent use of hormone-replacement therapy (HT) increases the risk of breast cancer [4,5]. However, the effect of HT on mortality from breast cancer is unclear [4,6]. Few estimates of the absolute increase in breast cancer incidence are available for users of oestrogen– progestagen HT. The Women’s Health Initiative Trial found an increased incidence of breast cancer in women who complied with treatment [8], of about six per 1000 women after 5 years use, and 18 per 1000 after 7 years use of oestrogen – progestagen HT; similar to results from the Million Women Study, based on substantially larger numbers, of an increase in the cumulative incidence of six [2,3] per 1000 for 10 years’ use of oestrogen – progestagen HT. In HT users tumors have been described to be more differentiated, small, and less aggressive with a major survival [9,10]. The frequency of breast cancer increases throughout the life span of women. However, there is no direct evidence to indicate that female hormones worsen the prognosis of this malignancy [11]. This is a retrospective, descriptive and cohort study that intends to determine the relationship between breast cancer and HT and its the relation with the histological findings. 2. Material and methods The study group consisted of 120 patients with breast cancer diagnosed and attended at Obstetrics and Gynecology service of Universitary Hospital ‘‘Dr Jose´ Eleuterio Gonza´lez’’ from January 1998 to January 2002. Date were collected at baseline on demographic characteristics, reproductive health history, smoking consumption, age at menarche, first birth, and menopause, parity, use and duration of HT, type of HT, history of benign breast disease, family history of breast cancer, previous diagnosis of contra lateral breast cancer, body mass index, height, history of lactation, use and durations of oral contraceptives, breast cancer stage and the histological type of carcinoma. 3. Results The study group consisted of 120 patients who ranged in age from 22 to 80 years (mean age from 49.8 years), body mass index from 20.8 to 42.8 (mean 29.7). The risk factor included. Age at menarche from 9 to 15 years (mean age 12 years), age at menopause from 0 to 56 years (mean 52 years), no lactation history was found in 40 patients (33.3%), nulliparous women was found in 28 patients (23.3%). The mean age first birth 24 years, history smoking consumption was found in 45 patients (37.5%) in the nonuser group HT and (38.8%) in the HT group. Twelve patients (10.1%) used oral contraceptives with duration from 5 to 13 years (mean 9.6 years), 18 patients (15%) who received HT with duration from 6 to 18 years (mean 8.5 years), 8 patients (44.4%) who received estrogen replacement therapy, 10 patients (55.6%) who received regimen of oestrogen– progestagen combination therapy. Seventeen patients HT users (94.4%) was found with stage III A disease, or earlier. The histological type that was most frequently
416
E. Rosales et al. / International Congress Series 1271 (2004) 414–416
found in HT users was the well differenced invasive ductal cancer, and in the HT nonuser group the histological type that was most frequently found was the bad differenced invasive ductal adenocarcinoma. 4. Conclusions The results of this study confirm previous findings that current and recent use of HT is associated with an increase of the incidence of breast cancer [4,7]. The age at the diagnosis of breast cancer in our population was an average of 49.8%, but is remarkable that 40% of our patients has 40 years or less at diagnosis time. Contrary to previous reports, our findings showed the stage at diagnosis time was III, this do not agree with the idea than HT users have earliest stages at diagnosis time, but in this study we also found that in HT users this tumors were better differentiated than in HT nonusers. The present study found HT apparently increases the risk of recurrence of breast cancer in the contra lateral breast in patients previously diagnosed with breast cancer [11]. References [1] C. Finley, et al., Disparities in hormone replacement therapy use by socioeconomic status in a primary care population, J. Commun. Health 26 (2001) 39 – 50. [2] C.L. Chen, et al., Hormone replacement therapy in relation to breast cancer, JAMA 287 (2002) 734 – 741. [3] K.H. Humphries, et al., Risks and benefits of hormone replacement therapy: the evidence speaks, Can. Med. Assoc. J. 168 (8) (2003) 1001 – 1010. [4] Collaborative Group on Hormonal Factors in Breast Cancer, Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52705 women with breast cancer and 108411 women without breast cancer, Lancet 350 (1997) 1047 – 1059. [5] V. Beral, E. Banks, G. Reeves, Evidence from randomized trials on the long-term effects of hormone replacement therapy, Lancet 360 (2002) 942 – 944. [6] V. Beral, et al., Use of HRT and the subsequent risk of cancer, J. Epidemiol. Biostat. 4 (1999) 191 – 215. [7] Cl. Li, et al., Relationship between long durations and different regimens of hormone therapy and risk of breast cancer, JAMA 289 (2003) 3254 – 3263. [8] R.T. Chlebowski, et al., Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women’s Health Initiative randomized trial, JAMA 289 (2003) 3243 – 3253. [9] S.M. Gapstur, M. Morrow, T.A. Selters, Hormone replacement therapy and risk of breast cancer with a favorable histology: results of the Iowa Women’s Health Study, JAMA 281 (1999) 2091 – 2097. [10] C. Schairer, et al., Estrogen replacement therapy and breast cancer survival in a large screening study, J. Natl. Cancer Inst. 91 (1999) 264 – 270. [11] K. Puthugramam, R. Natrajan, R. Don Gambrell, Estrogen replacement therapy in patients with early breast cancer, Am. J. Obstet. Gynecol. 187 (2002) 289 – 295.