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The use of estrogens and progestins and the risk of breast cancer in postmenopausal women.
Open accessAbstract
BACKGROUND: The effect of adding progestins to estrogen therapy on the risk of breast cancer in postmenopausal women is controversial. METHODS: To quantify the relation between the use of hormones and the risk of breast cancer in postmenopausal women, we extended our follow-up of the participants in the Nurses' Health Study to 1992. The women were asked to complete questionnaires every two years to update information on their menopausal status, use of estrogen and progestin preparations, and any diagnosis of breast cancer. During 725,550 person-years of follow-up, we documented 1935 cases of newly diagnosed invasive breast cancer. RESULTS: The risk of breast cancer was significantly increased among women who were currently using estrogen alone (relative risk, 1.32; 95 percent confidence interval, 1.14 to 1.54) or estrogen plus progestin (relative risk, 1.41; 95 percent confidence interval, 1.15 to 1.74), as compared with postmenopausal women who had never used hormones. Women currently taking hormones who had used such therapy for 5 to 9 years had an adjusted relative risk of breast cancer of 1.46 (95 percent confidence interval, 1.22 to 1.74), as did those currently using hormones who had done so for a total of 10 or more years (relative risk, 1.46; 95 percent confidence interval, 1.20 to 1.76). The increased risk of breast cancer associated with five or more years of postmenopausal hormone therapy was greater among older women (relative risk for women 60 to 64 years old, 1.71; 95 percent confidence interval, 1.34 to 2.18). The relative risk of death due to breast cancer was 1.45 (95 percent confidence interval, 1.01 to 2.09) among women who had taken estrogen for five or more years. CONCLUSIONS: The addition of progestins to estrogen therapy does not reduce the risk of breast cancer among postmenopausal women. The substantial increase in the risk of breast cancer among older women who take hormones suggests that the trade-offs between risks and benefits should be carefully assessed.
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“recent data suggest that progestins exert a negative impact on breast cancer (2-5), with recent reports indicating an increased risk of the disease in women (6,7).”
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“The use of ERT requires the addition of progestins to counteract the endometrial proliferation induced by estrogens, whereas both estrogens and progestins could increase the risk of breast cancer (5,318).”
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The Effects of Cyclical Etidronate on Early Postmenopausal Bone Loss
Heath, D. A., Bullivant, B., Boiven, C., & Balena, R. (2000) · Journal of Clinical Densitometry · doi:10.1385/jcd:3:1:027 · Cited by 9
Continuous Combined Estrogen/Progestin Hormone Replacement Therapy
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“[2] Colditz GA, Hankinson SE, Hunter DJ, et al.”
BackgroundEffect of physicians opinion on patients’ choice of treatment
Rozenberg, S., & HAM, H. (2001) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/s0301-2115(00)00461-9 · Cited by 9
Controversies in Management: Not for everybody
Jacobs, H. S. (1996) · BMJ · doi:10.1136/bmj.313.7053.351 · Cited by 9
Postmenopausal estrogen and progestin use and the risk of cardiovascular disease
Grodstein, F. (1997) · ACC Current Journal Review · doi:10.1016/s1062-1458(97)83305-3 · Cited by 9
Predictors of Quality of Life in Women: Hormone Therapy Self-Efficacy and Health-Promoting Behaviors
Ali, N. S. (1999) · Women & Health · doi:10.1300/j013v29n02_05 · Cited by 9
Use of estrogen for prevention and treatment of osteoporosis
Marcus, R. (1997) · Endocrine · doi:10.1007/bf02738967 · Cited by 9
Metadata
- Authors
- Colditz, G. A., Hankinson, S. E., Hunter, D. J., Willett, W. C., Manson, J. E., Stampfer, M. J., Hennekens, C., Rosner, B., & Speizer, F. E.
- Affiliations
- Brigham and Women's Hospital (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1995-06-15
- Volume
- 332
- Issue
- 24
- Pages
- 1589-1593
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2607238143
- Cited by
- 1,487
- References
- 32
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 6 · 2023: 8 · 2022: 8 · 2021: 13 · 2020: 13 · 2019: 11 · 2018: 17 · 2017: 16 · 2016: 16 · 2015: 18 · 2014: 21 · 2013: 18 · 2012: 26
- FWCI
- 111.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Cancer Institute (CA 40956)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Endocrinology › Estrogen and related hormone effects
- Health Sciences › Medicine › Oncology › Cancer Risks and Factors
- Keywords
- breast cancer risk, hormone replacement therapy, estrogen therapy, progestins, estrogen plus progestin, duration of hormone use, age-related risk, breast cancer mortality, Nurses' Health Study
- MeSH terms
- Aged, Breast Neoplasms, Estrogens, Female, Follow-Up Studies, Humans, Middle Aged, Progestins, Prospective Studies, Risk, Risk Factors, Cohort Studies, Estrogen Replacement Therapy, Confidence Intervals, Case-Control Studies, Postmenopause
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