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Association of Regimens of Hormone Replacement Therapy to Prognostic Factors among Women Diagnosed with Breast Cancer Aged 50–64 Years

¹ Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, Washington; ² University of Washington, School of Public Health and Community Medicine, Department of Epidemiology, Seattle, Washington; ³ Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California; ⁴ Cancer Division, Centers for Disease Control and Prevention, Atlanta, Georgia; ⁵ Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia; ⁶ Center for Clinical Epidemiology and Biostatistics and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; ⁷ Division of Epidemiology, Karmanos Cancer Institute at Wayne State University, Detroit, Michigan; ⁸ Bay State Medical Center, Department of Obstetrics and Gynecology, Springfield, Massachusetts; ⁹ Division of Hematology and Oncology, Karmanos Cancer Institute at Wayne State University, Detroit, Michigan; and ¹⁰ Contraception and Reproductive Health Branch, Center for Population Research, National Institute of Child Health and Human Development, Bethesda, Maryland

This study was conducted to assess the histopathological features of breast cancers in women diagnosed with breast cancer at 50–64 years of age who have and have not used hormone replacement therapy (HRT). A case-case analysis of the tumors from women aged 50–64 years who participated in a multicenter population-based case-control study of invasive breast cancer was conducted. In-person interviews collected a detailed history of all episodes of hormone use. Information was collected on selected tumor characteristics from 2346 women with breast cancer. Polytomous logistic regression was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs), contrasting the histopathological characteristics of the tumors of women who used various regimens of HRT with those of women who have never used HRT. The tumors of cases who used each regimen of HRT were smaller and of earlier stage than those of non-HRT users. Adjustment for screening diminished the magnitude of the effect, and only cases who used estrogen alone (estrogen replacement therapy) had reduced odds of being diagnosed with later-stage disease (regional or distant) than cases who never used HRT (OR, 0.7; 95% CI, 0.6–0.9). Higher proportions of estrogen receptor (ER)- and progesterone receptor (PR)-positive tumors were seen in cases who used any regimen of HRT versus those who did not use HRT. However, after adjustment for age and race, only the tumors of cases who used continuous combined HRT remained more likely to be ER+ and PR+ [OR ER- = 0.6 (95% CI, 0.4–0.9) and OR PR- = 0.5 (95% CI, 0.4–0.7)]. The tumors of women with breast cancer who used HRT have some better prognostic factors than those of women who have not used HRT. However, with the exception of the results noted above, this advantage may be due to the racial and age differences in those who use the various regimens of HRT and the effect of more frequent screening among HRT users, leading to earlier diagnosis.

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