Linda N Meurer1, Sarah Lená. 1. Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, 53226, USA. lmeurer@mcw.edu
Abstract
OBJECTIVES: We compared the risk of cancer recurrence and all-cause mortality among users and nonusers of estrogen replacement therapy (ERT) after the diagnosis of breast cancer. STUDY DESIGN: This was a systematic review of original research. Eligible studies were reviewed by 2 investigators who independently extracted data from each study according to a predetermined form and assessed each study for validity on standard characteristics. Meta-analyses were performed with Review Manager 4.1 to provide a summary of relative risks of cancer recurrence and mortality. POPULATION: Studies included 717 subjects who used hormone replacement therapy (HRT) at some time after their diagnosis of breast cancer, as well as 2545 subjects who did not use HRT. OUTCOMES MEASURED: Outcomes included breast cancer recurrence and all-cause mortality. RESULTS: Nine independent cohort studies and one 6-month pilot randomized controlled trial were identified. Studies were of variable quality. Breast cancer survivors using ERT experienced no increase in the risk of recurrence compared with controls (relative risk, 0.72; 95% confidence interval, 0.47-1.10) and had significantly fewer deaths (3.0%) than did the nonusers (11.4%) over the combined study periods (relative risk, 0.18; 95% confidence interval, 0.10-0.31). All tests for heterogeneity were nonsignificant. CONCLUSIONS: Although limited by observational design, existing research does not support the universal withholding of ERT from well-informed women with a previous diagnosis of low-stage breast cancer. Long-term randomized controlled trials are needed.
OBJECTIVES: We compared the risk of cancer recurrence and all-cause mortality among users and nonusers of estrogen replacement therapy (ERT) after the diagnosis of breast cancer. STUDY DESIGN: This was a systematic review of original research. Eligible studies were reviewed by 2 investigators who independently extracted data from each study according to a predetermined form and assessed each study for validity on standard characteristics. Meta-analyses were performed with Review Manager 4.1 to provide a summary of relative risks of cancer recurrence and mortality. POPULATION: Studies included 717 subjects who used hormone replacement therapy (HRT) at some time after their diagnosis of breast cancer, as well as 2545 subjects who did not use HRT. OUTCOMES MEASURED: Outcomes included breast cancer recurrence and all-cause mortality. RESULTS: Nine independent cohort studies and one 6-month pilot randomized controlled trial were identified. Studies were of variable quality. Breast cancer survivors using ERT experienced no increase in the risk of recurrence compared with controls (relative risk, 0.72; 95% confidence interval, 0.47-1.10) and had significantly fewer deaths (3.0%) than did the nonusers (11.4%) over the combined study periods (relative risk, 0.18; 95% confidence interval, 0.10-0.31). All tests for heterogeneity were nonsignificant. CONCLUSIONS: Although limited by observational design, existing research does not support the universal withholding of ERT from well-informed women with a previous diagnosis of low-stage breast cancer. Long-term randomized controlled trials are needed.
Authors: Anna Morra; Audrey Y Jung; Marjanka K Schmidt; Jenny Chang-Claude; Sabine Behrens; Renske Keeman; Thomas U Ahearn; Hoda Anton-Culver; Volker Arndt; Annelie Augustinsson; Päivi K Auvinen; Laura E Beane Freeman; Heiko Becher; Matthias W Beckmann; Carl Blomqvist; Stig E Bojesen; Manjeet K Bolla; Hermann Brenner; Ignacio Briceno; Sara Y Brucker; Nicola J Camp; Daniele Campa; Federico Canzian; Jose E Castelao; Stephen J Chanock; Ji-Yeob Choi; Christine L Clarke; Fergus J Couch; Angela Cox; Simon S Cross; Kamila Czene; Thilo Dörk; Alison M Dunning; Miriam Dwek; Douglas F Easton; Diana M Eccles; Kathleen M Egan; D Gareth Evans; Peter A Fasching; Henrik Flyger; Manuela Gago-Dominguez; Susan M Gapstur; José A García-Sáenz; Mia M Gaudet; Graham G Giles; Mervi Grip; Pascal Guénel; Christopher A Haiman; Niclas Håkansson; Per Hall; Ute Hamann; Sileny N Han; Steven N Hart; Mikael Hartman; Jane S Heyworth; Reiner Hoppe; John L Hopper; David J Hunter; Hidemi Ito; Agnes Jager; Milena Jakimovska; Anna Jakubowska; Wolfgang Janni; Rudolf Kaaks; Daehee Kang; Pooja Middha Kapoor; Cari M Kitahara; Stella Koutros; Peter Kraft; Vessela N Kristensen; James V Lacey; Diether Lambrechts; Loic Le Marchand; Jingmei Li; Annika Lindblom; Jan Lubiński; Michael Lush; Arto Mannermaa; Mehdi Manoochehri; Sara Margolin; Shivaani Mariapun; Keitaro Matsuo; Dimitrios Mavroudis; Roger L Milne; Taru A Muranen; William G Newman; Dong-Young Noh; Børge G Nordestgaard; Nadia Obi; Andrew F Olshan; Håkan Olsson; Tjoung-Won Park-Simon; Christos Petridis; Paul D P Pharoah; Dijana Plaseska-Karanfilska; Nadege Presneau; Muhammad U Rashid; Gad Rennert; Hedy S Rennert; Valerie Rhenius; Atocha Romero; Emmanouil Saloustros; Elinor J Sawyer; Andreas Schneeweiss; Lukas Schwentner; Christopher Scott; Mitul Shah; Chen-Yang Shen; Xiao-Ou Shu; Melissa C Southey; Daniel O Stram; Rulla M Tamimi; William Tapper; Rob A E M Tollenaar; Ian Tomlinson; Diana Torres; Melissa A Troester; Thérèse Truong; Celine M Vachon; Qin Wang; Sophia S Wang; Justin A Williams; Robert Winqvist; Alicja Wolk; Anna H Wu; Keun-Young Yoo; Jyh-Cherng Yu; Wei Zheng; Argyrios Ziogas; Xiaohong R Yang; A Heather Eliassen; Michelle D Holmes; Montserrat García-Closas; Soo Hwang Teo Journal: Cancer Epidemiol Biomarkers Prev Date: 2021-01-26 Impact factor: 4.090