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Breast cancer diagnosed during hormone replacement therapy
C Gajdos1, P I Tartter, A Babinszki
1Department of Surgery, The Mount Sinai Medical Center, New York, NY, USA.
Obstetrics and Gynecology
|March 22, 2000
Summary
Postmenopausal hormone replacement therapy (HRT) users had better breast cancer survival, likely due to earlier diagnosis via mammography. Data did not support hormonal influence on tumor biology affecting prognosis.
Area of Science:
- Oncology
- Endocrinology
- Radiology
Background:
- Hormone replacement therapy (HRT) use is linked to reduced breast cancer mortality, despite increased incidence.
- The reasons for this paradox remain unclear, with possibilities including earlier diagnosis, less aggressive tumors, or hormonal effects.
Purpose of the Study:
- To investigate the factors contributing to the improved breast cancer survival observed in postmenopausal hormone users.
- To determine if earlier diagnosis, tumor biology, or cessation of hormonal stimulation explains the HRT-associated survival benefit.
Main Methods:
- A comparative study of 455 postmenopausal breast cancer patients who did not use HRT versus 47 who did prior to diagnosis.
- Analysis of demographic, clinical, pathological, treatment, and outcome data.
Main Results:
- Hormone users were younger, leaner, and more often diagnosed via nonpalpable mammographic findings, leading to smaller tumors with less nodal involvement.
- Cancers in hormone users were more frequently invasive lobular or ductal carcinoma in situ (DCIS) and steroid receptor-positive.
- Hormone users had significantly lower rates of local recurrence (0% vs. 8%) and distant disease (7% vs. 10%) at 5 years compared to nonusers.
Conclusions:
- Earlier detection through mammography appears to be the primary driver of improved breast cancer survival in postmenopausal hormone users.
- The study found no evidence to support a direct hormonal influence on tumor biology or prognosis in this cohort.