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Postmenopausal hormone therapy and breast cancer: a systematic review and meta-analysis

Shah, Nirav R MD, MPH1; Borenstein, Jeff MD, MPH2; Dubois, Robert W MD, PhD3

doi: 10.1097/01.gme.0000184221.63459.e1
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Objective: There is a rapidly evolving debate on the indications and appropriate duration of therapy for postmenopausal hormone therapy. The objective of this meta-analysis was to examine the specific relationships of postmenopausal estrogen therapy (ET), postmenopausal combined (estrogen-progestogen) hormone therapy (CHT), and the incidence of breast cancer.

Design: We performed computerized searches of MEDLINE and CancerLit through September 2003 and reviewed reference lists of retrieved studies and meta-analyses. We included English-language studies that identified noncontraceptive postmenopausal hormone use; reported on the risks of “current use” of ET and/or CHT and breast cancer incidence; were case-control, cohort, or experimental; and reported either an odds ratio (OR), relative risk (RR), or HR with CIs. Two investigators were involved during all stages of study selection and independently extracted all data selected for inclusion in meta-analyses.

Results: Meta-analysis of 13 studies of ET and breast cancer (700,000 women) resulted in an OR of 1.16 (95% confidence limits [CL] 1.06, 1.28), with estimates for less than 5 years use 1.16 (1.02, 1.32) and more than 5 years use 1.20 (1.06, 1.37). Meta-analysis of eight studies of CHT and breast cancer (650,000 women) resulted in an OR of 1.39 (95% CL 1.12, 1.72), with estimates for less than 5 years use 1.35 (1.16, 1.57) and more than 5 years use 1.63 (1.22, 2.18).

Conclusions: Data from observational studies support the association of increased but considerably different risks for breast cancer incidence among current users of ET and CHT. These represent the first pooled estimates for ET. CHT estimates correspond to those from randomized trials.

Data from observational studies support the association of increased but considerably different risks for breast cancer incidence among current users of postmenopausal estrogen therapy and postmenopausal combined (estrogen-progestogen) hormone therapy.

From the 1Division of General Internal Medicine, Department of Medicine, New York University School of Medicine, New York, NY; 2Cedars-Sinai Department of General Internal Medicine and Health Services Research, Los Angeles, CA; and 3Cerner Health Insights, Los Angeles, CA.

Received November 5, 2004; revised and accepted February 14, 2005.

The funding sources, Berlex Labs and the VA/RWJ Clinical Scholars Program, had no role in the collection, analysis, or interpretation of the data or in the decision to submit the manuscript for publication.

Address correspondence to: Nirav R. Shah, MD, MPH, 200 East 61st Street #26A, New York, NY 10021. E-mail: nirav.shah@med.nyu.edu.

©2005The North American Menopause Society