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Human Reproduction Update Advance Access published online on September 8, 2005
Human Reproduction Update, doi:10.1093/humupd/dmi031
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© The Author 2005. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org
Received February 3, 2005
Revised June 14, 2005
Accepted July 18, 2005

Article

Menopausal hormone therapy and risk of breast cancer: a meta-analysis of epidemiological studies and randomized controlled trials

Claudia M. Greiser 1, Eberhard M. Greiser 2, and Martina Dören 3*

1 Epi. Consult GmbH, Bremen
2 Epi. Consult GmbH; Institute for Public Health and Nursing Research, Bremen University, Bremen
3 Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Clinical Research Center of Women’s Health, Berlin, Germany

* To whom correspondence should be addressed.
Martina Dören, E-mail: martina.doeren{at}charite.de


  Abstract

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.

Keywords: breast cancer/estrogen-progestin therapy/hormone replacement therapy/menopausal hormone therapy/unopposed estrogen therapy.
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