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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front Med Chin    2010, Vol. 4 Issue (3) : 290-293     DOI: 10.1007/s11684-010-0093-7
How to judge the association of postmenopausal hormone therapy and the risk of breast cancer
Ling XU()
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China
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The relevance of postmenopausal hormone therapy (HT) for breast cancer risk has been long debated, although it is one of the most important barriers for women to accept HT. Various opinions have been reported from recent randomized clinical trials and epidemiological studies. These unanswered questions include: whether HT has a positive impact on breast cancer; whether risks of therapy with unopposed estrogen and combined estrogen-progestin are different; and whether different types and routes of estrogen and progestogens, as well as the duration and cessation of HT use, have different impacts on this disorder. Recently, there has been some good news such as the following: the currently available data do not provide sufficient evidence to prove a causal relationship between postmenopausal HT and breast cancer; breast cancer in postmenopausal women using HT usually has better prognosis than that of nonusers. In conclusion, HT is still the most effective method of relieving climacteric symptoms for many postmenopausal women. However, a possible risk of breast cancer associated with long-term HT usage should not be ignored. With respect to prevention of breast cancer, regular evaluation of individual breast cancer susceptibility and close follow-up through mammography and/or breast sonography are necessary strategies for the safety of HT use.

Keywords breast cancer      postmenopausal hormone therapy      unopposed estrogen therapy      combined estrogen-progestin therapy     
Corresponding Authors: XU Ling,   
Issue Date: 05 September 2010
URL:     OR
Fig.1  Hormone therapy usage in Asia
1 Verkooijen H M, Bouchardy C, Vinh-Hung V, Rapiti E, Hartman M. The incidence of breast cancer and changes in the use of hormone replacement therapy: a review of the evidence. Maturitas , 2009, 64(2): 80–85
doi: 10.1016/j.maturitas.2009.07.015
2 Sharpe K H, McClements P, Clark D I, Collins J, Springbett A, Brewster D H. Reduced risk of oestrogen receptor positive breast cancer among peri- and post-menopausal women in Scotland following a striking decrease in use of hormone replacement therapy. Eur J Cancer , 2010, 46(5): 937–943
doi: 10.1016/j.ejca.2010.01.003
3 Parkin D M. Is the recent fall in incidence of post-menopausal breast cancer in UK related to changes in use of hormone replacement therapy? Eur J Cancer , 2009, 45(9): 1649–1653
doi: 10.1016/j.ejca.2009.01.016
4 Katalinic A, Lemmer A, Zawinell A, Rawal R, Waldmann A. Trends in hormone therapy and breast cancer incidence– results from the German Network of Cancer Registries. Pathobiology , 2009, 76(2): 90–97
doi: 10.1159/000201677
5 Jemal A, Ward E, Thun M. Recent trends in breast cancer incidence rates by age and tumor characteristics among US women. Breast Cancer Res , 2007, 9(3): 108
doi: 10.1186/bcr1672
6 Canfell K, Banks E, Moa A M, Beral V. Decrease in breast cancer incidence following a rapid fall in use of hormone replacement therapy in Australia. Med J Aust , 2008, 188(11): 641–644
7 Writing Group for the Women’s Health Initiative Investigators. Risks and benefits of estrogen plus progesterone in healthy post-menopausal women. JAMA , 2002, 288(3): 321–333
8 Huang K E, Xu L, I N N, Jaisamrarn U. The Asian Menopause Survey: knowledge, perceptions, hormone treatment and sexual function. Maturitas , 2010, 65(3): 276–283
doi: 10.1016/j.maturitas.2009.11.015
9 Gramling R, Eaton C B, Rothman K J, Cabral H, Silliman R A, Lash T L. Hormone replacement therapy, family history, and breast cancer risk among postmenopausal women. Epidemiology , 2009, 20(5): 752–756
doi: 10.1097/EDE.0b013e3181a71279
10 Pines A, Sturdee D W, Birkh?user M H, Schneider H P, Gambacciani M, Panay N. IMS updated recommendations on postmenopausal hormone therapy. Climacteric , 2007, 10(3): 181–194
doi: 10.1080/13697130701361657
11 Bush T L, Whiteman M, Flaws J A. Hormone replacement therapy and breast cancer: a qualitative review. Obstet Gynecol , 2001, 98(3): 498–508
doi: 10.1016/S0029-7844(01)01453-3
12 Chlebowski R T, Hendrix S L, Langer R D, Stefanick M L, Gass M, Lane D, Rodabough R J, Gilligan M A, Cyr M G, Thomson C A, Khandekar J, Petrovitch H, McTiernan A; WHI Investigators. Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women’s Health Initiative randomized trial. JAMA , 2003, 289(24): 3243–3253
13 Beral V, for the Million Women Study Collaborators. Breast cancer and hormone-replacement therapy in the Million Women Study. Lancet , 2003, 362(9382): 419–427
doi: 10.1016/S0140-6736(03)14065-2
14 Anderson G L, Limacher M, Assaf A R, Bassford T, Beresford S A, Black H, Bonds D, Brunner R, Brzyski R, Caan B, Chlebowski R, Curb D, Gass M, Hays J, Heiss G, Hendrix S, Howard B V, Hsia J, Hubbell A, Jackson R, Johnson K C, Judd H, Kotchen J M, Kuller L, LaCroix A Z, Lane D, Langer R D, Lasser N, Lewis C E, Manson J, Margolis K, Ockene J, O'Sullivan M J, Phillips L, Prentice R L, Ritenbaugh C, Robbins J, Rossouw J E, Sarto G, Stefanick M L, Van Horn L, Wactawski-Wende J, Wallace R, Wassertheil-Smoller S; Women's Health Initiative Steering Committee. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy. JAMA , 2004, 291(14): 1701–1712
15 Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52,705 women with breast cancer and 108,411 women without breast cancer. Lancet , 1997, 350(9084): 1047-1059 Erratum in. Lancet , 1997, 350(9089): 1484
doi: 10.1016/S0140-6736(05)64259-6
16 Li C I, Malone K E, Porter P L, Weiss N S, Tang M T, Cushing-Haugen K L, Daling J R. Relationship between long durations and different regimens of hormone therapy and risk of breast cancer. JAMA , 2003, 289(24): 3254–3263
17 Gadducci A, Biglia N, Cosio S, Sismondi P, Genazzani A R. Progestagen component in combined hormone replacement therapy in postmenopausal women and breast cancer risk: a debated clinical issue. Gynecol Endocrinol , 2009, 25(12): 807–815
doi: 10.3109/09513590903056878
18 Santen R J. Does menopausal hormone therapy initiate new breast cancers or promote the growth of existing ones? Womens Health (Lond Engl) , 2008, 4(3): 207–210
doi: 10.2217/17455057.4.3.207
19 Jernstr?m H, Frenander J, Fern? M, Olsson H. Hormone replacement therapy before breast cancer diagnosis significantly reduces the overall death rate compared with never-use among 984 breast cancer patients. Br J Cancer , 1999, 80(9): 1453–1458
doi: 10.1038/sj.bjc.6690543
20 Nanda K, Bastian L A, Schulz K. Hormone replacement therapy and the risk of death from breast cancer: a systematic review. Am J Obstet Gynecol , 2002, 186(2): 325–334
doi: 10.1067/mob.2002.121077
21 Chen W Y, Manson J E, Hankinson S E, Rosner B, Holmes M D, Willett W C, Colditz G A. Unopposed estrogen therapy and the risk of invasive breast cancer. Arch Intern Med , 2006, 166(9): 1027–1032
doi: 10.1001/archinte.166.9.1027
22 Fowble B, Hanlon A, Freedman G, Patchefsky A, Kessler H, Nicolaou N, Hoffman J, Sigurdson E, Boraas M, Goldstein L. Postmenopausal hormone replacement therapy: effect on diagnosis and outcome in early-stage invasive breast cancer treated with conservative surgery and radiation. J Clin Oncol , 1999, 17(6): 1680–1688
23 Chlebowski R T, Kuller L H, Prentice R L, Stefanick M L, Manson J E, Gass M, Aragaki A K, Ockene J K, Lane D S, Sarto G E, Rajkovic A, Schenken R, Hendrix S L, Ravdin P M, Rohan T E, Yasmeen S, Anderson G, for the WHI Investigators. Breast cancer after use of estrogen plus progestin in postmenopausal women. N Engl J Med , 2009, 360(6): 573–587
doi: 10.1056/NEJMoa0807684
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