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Estrogen plus progestin and breast cancer incidence and mortality in the women's health initiative observational study

Chlebowski, RT and Manson, JE and Anderson, GL and Cauley, JA and Aragaki, AK and Stefanick, ML and Lane, DS and Johnson, KC and Wactawski-Wende, J and Chen, C and Qi, L and Yasmeen, S and Newcomb, PA and Prentice, RL (2013) Estrogen plus progestin and breast cancer incidence and mortality in the women's health initiative observational study. Journal of the National Cancer Institute, 105 (8). 526 - 535. ISSN 0027-8874

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Abstract

Background In the Women's Health Initiative (WHI) randomized trial, estrogen plus progestin increased both breast cancer incidence and mortality. In contrast, most observational studies associate estrogen plus progestin with favorable prognosis breast cancers. To address differences, a cohort of WHI observational study participants with characteristics similar to the WHI clinical trial was studied.MethodsWe identified 41 449 postmenopausal women with no prior hysterectomy and mammogram negative within 2 years who were either not hormone users (n = 25 328) or estrogen and progestin users (n = 16 121). Multivariable-adjusted Cox proportional hazard regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CI). All statistical tests were two-sided.ResultsAfter a mean of 11.3 (SD = 3.1) years, with 2236 breast cancers, incidence was higher in estrogen plus progestin users than in nonusers (0.60% vs 0.42%, annualized rate, respectively; HR = 1.55, 95% CI = 1.41 to 1.70, P <. 001). Women initiating hormone therapy closer to menopause had higher breast cancer risk with linear diminishing influence as time from menopause increased (P <. 001). Survival after breast cancer, measured from diagnosis, was similar in combined hormone therapy users and nonusers (HR = 1.03, 95% CI = 0.79 to 1.35). On a population basis, there were somewhat more deaths from breast cancer, measured from cohort entry (HR = 1.32, 95% CI = 0.90 to 1.93, P =. 15), and more all-cause deaths after breast cancer (HR = 1.65, 95% CI = 1.29 to 2.12, P <. 001) in estrogen plus progestin users than in nonusers.ConclusionsConsistent with WHI randomized trial findings, estrogen plus progestin use is associated with increased breast cancer incidence. Because prognosis after diagnosis on combined hormone therapy is similar to that of nonusers, increased breast cancer mortality can be expected. © 2013 The Author.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Chlebowski, RT
Manson, JE
Anderson, GL
Cauley, JAJCauley@edc.pitt.eduJCAULEY
Aragaki, AK
Stefanick, ML
Lane, DS
Johnson, KC
Wactawski-Wende, J
Chen, C
Qi, L
Yasmeen, S
Newcomb, PA
Prentice, RL
Date: 17 April 2013
Date Type: Publication
Journal or Publication Title: Journal of the National Cancer Institute
Volume: 105
Number: 8
Page Range: 526 - 535
DOI or Unique Handle: 10.1093/jnci/djt043
Schools and Programs: Graduate School of Public Health > Epidemiology
Refereed: Yes
ISSN: 0027-8874
Date Deposited: 03 Apr 2015 01:21
Last Modified: 02 Feb 2019 23:55
URI: http://d-scholarship.pitt.edu/id/eprint/24233

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