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Decline in hormone replacement prescription and fall in breast cancer incidence: an epidemiological discourse
1Sektion Klinische Epidemiologie, Institut für Medizinische Epidemiologie, Biometrie und Informatik, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Magdeburger Strasse 8, Halle, Germany. andreas.stang@medizin.uni-halle.de
Introduction:
Between 2002 and 2003 the incidence of invasive breast cancer among women aged 50 to 69 years declined considerably in the US. This decline was accompanied by a substantial fall in prescription rates of estrogen-progestin (EG-HRT).
Methods:
Selective literature search in PubMed from 01/2003 to 12/2007 using the key words "hormone replacement therapy," "incidence," and "breast cancer."
Results:
The parallel decline in EG-HRT and breast cancer suggests a causal link. Up to now, alternative explanations for the decline of the incidence can either be refuted or revealed as implausible.
Discussion:
Detailed incidence trend analyses in the coming years and a close monitoring of EG-HRT prescription rates in and beyond the US. promise important insights. If EG-HRTs are carcinogenic, the extent of this effect remains unclear. If cessation of EG-HRT therapy only delays the appearance of detectable breast cancer, a long-term increase in incidence would be expected in women of age 50 and older, even with low prescription rates. However, if cessation of EG-HRT also stops tumor growth, the anticipated incidence will be permanently lower in the future.
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