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[Hormone replacement and breast carcinoma].

M Birkhäuser¹

¹Frauenklinik, Universitätsspital Bern. martin.birkhaeuser@insel.ch

|January 11, 2003

Summary

Postmenopausal hormone therapy, including estrogen-progestagen combinations, shows a slightly increased breast cancer risk, particularly after 5 years. Estrogen-only therapy and newer agents like Tibolone and Raloxifene may have different effects.

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Area of Science:

Endocrinology
Oncology
Epidemiology

Background:

Postmenopausal hormone therapy (PHT) is widely used, necessitating a clear understanding of its effects on breast health.
Assessing the breast cancer risk associated with PHT is crucial for informed clinical decision-making.

Purpose of the Study:

To review the impact of various PHT agents (Oestrogens, Progestagens, Tibolone, Raloxifene, Phytooestrogens) on breast cancer risk in postmenopausal women.
To differentiate between relative and absolute risk in the context of PHT and breast cancer.

Main Methods:

Review of epidemiological data from observational studies, meta-analyses, and reanalyses, including the Women's Health Initiative (WHI) trial.
Analysis of relative and absolute risk data for breast cancer in relation to different PHT formulations and treatment durations.

Main Results:

Most PHT use shows relative breast cancer risk within clinically insignificant limits, comparable to young smokers.
Estrogen-progestagen combinations in the WHI showed a slight increase in risk, while estrogen-only therapy did not.
Breast cancer risk increases with PHT duration, becoming apparent after 4-5 years, with an absolute increase of 2 cases per 1000 women after 5 years.

Conclusions:

The absolute risk of breast cancer with PHT is small, and relative risks are often within acceptable limits.
Estrogen-progestagen therapy may carry a higher breast cancer risk than estrogen-only therapy.
Long-term data on Tibolone, Raloxifene, and Phytooestrogens are needed to confirm their safety and potential protective effects on breast tissue.

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