Type your tag names separated by a space and hit enter

Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women's Health Initiative Randomized Trial.

Abstract

CONTEXT

The Women's Health Initiative trial of combined estrogen plus progestin was stopped early when overall health risks, including invasive breast cancer, exceeded benefits. Outstanding issues not previously addressed include characteristics of breast cancers observed among women using hormones and whether diagnosis may be influenced by hormone effects on mammography.

OBJECTIVE

To determine the relationship among estrogen plus progestin use, breast cancer characteristics, and mammography recommendations.

DESIGN, SETTING, AND PARTICIPANTS

Following a comprehensive breast cancer risk assessment, 16 608 postmenopausal women aged 50 to 79 years with an intact uterus were randomly assigned to receive combined conjugated equine estrogens (0.625 mg/d) plus medroxyprogesterone acetate (2.5 mg/d) or placebo from 1993 to 1998 at 40 clinical centers. Screening mammography and clinical breast examinations were performed at baseline and yearly thereafter.

MAIN OUTCOME MEASURES

Breast cancer number and characteristics, and frequency of abnormal mammograms by estrogen plus progestin exposure.

RESULTS

In intent-to-treat analyses, estrogen plus progestin increased total (245 vs 185 cases; hazard ratio [HR], 1.24; weighted P<.001) and invasive (199 vs 150 cases; HR, 1.24; weighted P =.003) breast cancers compared with placebo. The invasive breast cancers diagnosed in the estrogen plus progestin group were similar in histology and grade but were larger (mean [SD], 1.7 cm [1.1] vs 1.5 cm [0.9], respectively; P =.04) and were at more advanced stage (regional/metastatic 25.4% vs 16.0%, respectively; P =.04) compared with those diagnosed in the placebo group. After 1 year, the percentage of women with abnormal mammograms was substantially greater in the estrogen plus progestin group (716 [9.4%] of 7656) compared with placebo group (398 [5.4%] of 7310; P<.001), a pattern which continued for the study duration.

CONCLUSIONS

Relatively short-term combined estrogen plus progestin use increases incident breast cancers, which are diagnosed at a more advanced stage compared with placebo use, and also substantially increases the percentage of women with abnormal mammograms. These results suggest estrogen plus progestin may stimulate breast cancer growth and hinder breast cancer diagnosis.

Links

  • Publisher Full Text
  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Harbor-UCLA Research and Education Institute, Torrance 90502, USA. rchlebowski@rei.edu

    , , , , , , , , , , , ,

    Source

    JAMA 289:24 2003 Jun 25 pg 3243-53

    MeSH

    Aged
    Breast Neoplasms
    Estrogen Replacement Therapy
    Estrogens, Conjugated (USP)
    Female
    Follow-Up Studies
    Humans
    Mammography
    Medroxyprogesterone Acetate
    Middle Aged
    Neoplasm Staging
    Postmenopause
    Progesterone Congeners
    Proportional Hazards Models
    Risk

    Pub Type(s)

    Clinical Trial
    Journal Article
    Multicenter Study
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    12824205

    Citation

    Chlebowski, Rowan T., et al. "Influence of Estrogen Plus Progestin On Breast Cancer and Mammography in Healthy Postmenopausal Women: the Women's Health Initiative Randomized Trial." JAMA, vol. 289, no. 24, 2003, pp. 3243-53.
    Chlebowski RT, Hendrix SL, Langer RD, et al. Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women's Health Initiative Randomized Trial. JAMA. 2003;289(24):3243-53.
    Chlebowski, R. T., Hendrix, S. L., Langer, R. D., Stefanick, M. L., Gass, M., Lane, D., ... McTiernan, A. (2003). Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women's Health Initiative Randomized Trial. JAMA, 289(24), pp. 3243-53.
    Chlebowski RT, et al. Influence of Estrogen Plus Progestin On Breast Cancer and Mammography in Healthy Postmenopausal Women: the Women's Health Initiative Randomized Trial. JAMA. 2003 Jun 25;289(24):3243-53. PubMed PMID: 12824205.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women's Health Initiative Randomized Trial. AU - Chlebowski,Rowan T, AU - Hendrix,Susan L, AU - Langer,Robert D, AU - Stefanick,Marcia L, AU - Gass,Margery, AU - Lane,Dorothy, AU - Rodabough,Rebecca J, AU - Gilligan,Mary Ann, AU - Cyr,Michele G, AU - Thomson,Cynthia A, AU - Khandekar,Janardan, AU - Petrovitch,Helen, AU - McTiernan,Anne, AU - ,, PY - 2003/6/26/pubmed PY - 2003/7/9/medline PY - 2003/6/26/entrez SP - 3243 EP - 53 JF - JAMA JO - JAMA VL - 289 IS - 24 N2 - CONTEXT: The Women's Health Initiative trial of combined estrogen plus progestin was stopped early when overall health risks, including invasive breast cancer, exceeded benefits. Outstanding issues not previously addressed include characteristics of breast cancers observed among women using hormones and whether diagnosis may be influenced by hormone effects on mammography. OBJECTIVE: To determine the relationship among estrogen plus progestin use, breast cancer characteristics, and mammography recommendations. DESIGN, SETTING, AND PARTICIPANTS: Following a comprehensive breast cancer risk assessment, 16 608 postmenopausal women aged 50 to 79 years with an intact uterus were randomly assigned to receive combined conjugated equine estrogens (0.625 mg/d) plus medroxyprogesterone acetate (2.5 mg/d) or placebo from 1993 to 1998 at 40 clinical centers. Screening mammography and clinical breast examinations were performed at baseline and yearly thereafter. MAIN OUTCOME MEASURES: Breast cancer number and characteristics, and frequency of abnormal mammograms by estrogen plus progestin exposure. RESULTS: In intent-to-treat analyses, estrogen plus progestin increased total (245 vs 185 cases; hazard ratio [HR], 1.24; weighted P<.001) and invasive (199 vs 150 cases; HR, 1.24; weighted P =.003) breast cancers compared with placebo. The invasive breast cancers diagnosed in the estrogen plus progestin group were similar in histology and grade but were larger (mean [SD], 1.7 cm [1.1] vs 1.5 cm [0.9], respectively; P =.04) and were at more advanced stage (regional/metastatic 25.4% vs 16.0%, respectively; P =.04) compared with those diagnosed in the placebo group. After 1 year, the percentage of women with abnormal mammograms was substantially greater in the estrogen plus progestin group (716 [9.4%] of 7656) compared with placebo group (398 [5.4%] of 7310; P<.001), a pattern which continued for the study duration. CONCLUSIONS: Relatively short-term combined estrogen plus progestin use increases incident breast cancers, which are diagnosed at a more advanced stage compared with placebo use, and also substantially increases the percentage of women with abnormal mammograms. These results suggest estrogen plus progestin may stimulate breast cancer growth and hinder breast cancer diagnosis. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/12824205/full_citation L2 - https://jamanetwork.com/journals/jama/fullarticle/vol/289/pg/3243 DB - PRIME DP - Unbound Medicine ER -