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Prognostic Characteristics of Breast Cancer Among Postmenopausal Hormone Users in a Screened Population

Karla Kerlikowske, Diana L. Miglioretti, Rachel Ballard-Barbash, Donald L. Weaver, Diana S.M. Buist, William E. Barlow, Gary Cutter, Berta M. Geller, Bonnie Yankaskas, Stephen H. Taplin, Patricia A. Carney

From the Department of Epidemiology and Biostatistics, and the General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA; Center for Health Studies, Group Health Cooperative; Department of Biostatistics, University of Washington, Seattle, WA; Applied Research Program, DCCPS, National Cancer Institute, Bethesda, MD; Department of Pathology, and Health Promotion Research, University of Vermont, College of Medicine, Burlington, VT; Center for Research Design and Statistical Methods, University of Nevada School of Medicine, Applied Research Facility, Reno, NV; Department of Radiology, University of North Carolina, Chapel Hill, NC; Norris Cotton Cancer Center/Dartmouth-Hitchcock Medical Center/Department of Community and Family Medicine, Dartmouth Medical School, Lebanon, NH.

Address reprint requests to Karla Kerlikowske, MD, San Francisco Veterans Affairs Medical Center, General Internal Medicine Section, 111A1, 4150 Clement St, San Francisco, CA 94121; e-mail: kerliko{at}itsa.ucsf.edu.

Purpose: We determined the risk of breast cancer and tumor characteristics among current postmenopausal hormone therapy users compared with nonusers, by duration of use.

Methods: From January 1996 to December 2000, data were collected prospectively on 374,465 postmenopausal women aged 50 to 79 years who underwent screening mammography. We calculated the relative risk (RR) of breast cancer (invasive or ductal carcinoma-in-situ) and type of breast cancer within 12 months of postmenopausal therapy use among current hormone users with a uterus (proxy for estrogen and progestin use) and without a uterus (proxy for estrogen use), compared with nonusers.

Results: Compared with nonusers, women using estrogen and progestin for 5 years were at increased risk of breast tumors of stage 0 or I (RR, 1.51; 95% CI, 1.37 to 1.66), stage II or higher (RR, 1.46; 95% CI, 1.30 to 1.63), size 20 mm (RR, 1.59; 95% CI, 1.43 to 1.76), size greater than 20 mm (RR, 1.24; 95% CI, 1.09 to 1.42), grade 1 or 2 (RR, 1.60; 95% CI, 1.44 to 1.77), grade 3 or 4 (RR, 1.54; 95% CI, 1.37 to 1.73), and estrogen receptor-positive (RR, 1.72; 95% CI, 1.55 to 1.90). Estrogen-only users were slightly more likely to have estrogen receptor-positive breast cancer compared with nonusers (RR, 1.14; 95% CI, 1.06 to 1.23).

Conclusion: Use of estrogen and progestin postmenopausal hormone therapy for five years or more increased the likelihood of developing breast cancer, including both tumors with favorable prognostic features and tumors with unfavorable prognostic features.

This work was supported by a National Cancer Institute–funded Breast Cancer Surveillance Consortium cooperative agreement (U01CA63740, U01CA86076, U01CA86082, U01CA63736, U01CA70013, U01CA69976, U01CA63731, U01CA70040).

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