Human Reproduction Update Advance Access originally published online on September 8, 2005
Human Reproduction Update 2005 11(6):561-573; doi:10.1093/humupd/dmi031
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Menopausal hormone therapy and risk of breast cancer: a meta-analysis of epidemiological studies and randomized controlled trials
1 Epi. Consult GmbH, 2 Institute for Public Health and Nursing Research, Bremen University, Bremen and 3 Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Clinical Research Center of Women’s Health, Berlin, Germany
4 To whom correspondence should be addressed at: Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, D-12200 Berlin, Germany. E-mail: martina.doeren{at}charite.de
Submitted on February 3, 2005; revised on June 14, 2005; accepted on July 18, 2005
We conducted meta-analyses to assess the impact of menopausal hormone therapy (MHT) on the risk of incident invasive breast cancer (BC) in cohort studies (CS), case–control studies (CCS) and randomized controlled trials (RCTs) published 1989–2004. We used published data providing information upon unopposed estrogen therapy (ET), estrogen–progestin therapy (EPT) or all MHT combined. Major outcomes were MHT-associated overall risk of BC and change of risk per year used. There is a linear increase of overall risk by midterm year of case ascertainment based upon data of all study types for MHT and to a larger extent for EPT, not for ET. Effects are larger in CS than in CCS. Meta-analyses stratified by <1992 versus $1992 as midterm year of case ascertainment indicate larger summary risks for the latter period for all MHT analysed, in particular for EPT. Annual increases in BC risk for EPT across study types are 0–9%, for ET 0–3%. In conclusion, there is evidence that relative risks for BC risks by MHT, in particular EPT, have been increasing in recent years. Given the widespread use of MHT, and often long duration, more detailed knowledge about differential BC risks of both estrogens and progestins are necessary to minimize BC risk in symptomatic women who consider MHT.
Key words: breast cancer / estrogen–progestin therapy / hormone replacement therapy / menopausal hormone therapy / unopposed estrogen therapy
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