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Postmenopausal Hormone Replacement Therapy: Effect on Diagnosis and Outcome in Early-Stage Invasive Breast Cancer Treated With Conservative Surgery and Radiation

From the Division of Population Science, Department of Biostatistics, and Departments of Radiation Oncology, Radiology, Pathology, and Surgery, Fox Chase Cancer Center, Philadelphia, PA.

Address reprint requests to Barbara Fowble, MD, Department of Radiation Oncology, Fox Chase Cancer Center, 7701 Burholme Ave, Philadelphia, PA 19111; e-mail b_fowble{at}fccc.edu

PURPOSE: To compare the pretreatment characteristics and outcome of postmenopausal women with stage I-II breast cancer treated with conservative surgery and radiation who had a history of hormone replacement therapy (HRT) with those who had never received HRT.

MATERIALS AND METHODS: From 1979 to 1993, 485 postmenopausal women underwent excisional biopsy, axillary dissection, and radiation for stage I-II breast cancer. The median follow-up was 5.9 years. One hundred forty-one patients reported a history of HRT. The median length of use was 5 years. Three hundred forty-four patients reported no history of HRT.

RESULTS: Statistically significant differences between the two groups were observed for median age (HRT 60 years v no HRT 64 years; P = .0009), median weight (HRT 142 lbs v no HRT 152 lbs; P = .004), clinical tumor size 2 cm (HRT 77% v no HRT 66%; P = .02), and the use of re-excision (HRT 62% v no HRT 49%; P = .01). The method of detection by mammogram only (HRT 52% v no HRT 42%; P = .06) was of borderline statistical significance. The HRT patients had a statistically significant increased cumulative incidence of ipsilateral breast tumor recurrence (8% v 2%; P = .02), a statistically significant decreased cumulative incidence of distant metastases (HRT 6% v no HRT 17%; P = .01), and a borderline statistically significant improvement in cause-specific survival at 10 years (HRT 92% v no HRT 86%; P = .07). Postmenopausal women with a history of HRT did not have an increased risk of contralateral breast cancer or second non–breast cancer malignancy.

CONCLUSION: This study failed to identify an adverse effect of HRT on breast cancer mortality in patients with stage I-II disease treated with conservative surgery and radiation.

Presented at the 40th Annual Meeting of the American Society for Therapeutic Radiology and Oncology, Phoenix, AZ, October 28, 1998.

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