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Relationship between menopausal hormone therapy and mortality after breast cancer The MARIE plus study, a prospective case cohort
Author(s) -
Obi Nadia,
Heinz Judith,
Seibold Petra,
Vrieling Alina,
Rudolph Anja,
ChangClaude Jenny,
Berger Jürgen,
FleschJanys Dieter
Publication year - 2015
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.29951
Subject(s) - medicine , breast cancer , hazard ratio , proportional hazards model , cohort , hormone therapy , prospective cohort study , oncology , cohort study , estrogen receptor , population , cancer , gynecology , confidence interval , environmental health
Cohort studies of breast cancer (BC) patients, but not of disease‐free women at inclusion, have found menopausal hormone therapy (MHT) to be associated with decreased BC specific mortality (BCM). Here, the German population‐based MARIE plus BC cohort was analyzed to further elucidate associations of prediagnostic MHT with BCM (and modification by tumor characteristics), recurrence, and secondarily with other cause and overall mortality. Enrolled 2002–2005, incident invasive BC cases ( N = 3,321) were followed up for a median of 6.1 years. Cox proportional hazards models adjusted for tumor characteristics, mammography and lifestyle were applied. Compared with never users of MHT, current users at date of diagnosis had significantly lower BCM (Hazard ratio (HR) 0.72, 95% CI 0.53–0.97) and risk of recurrence (HR 0.61, 95% CI 0.46–0.82). The MHT related reduced BCM was confined to patients with low grade tumors (HR 0.44, 95% CI 0.28–0.70; p het = 0.01) and not modified by estrogen receptor or nodal status. BCM decreased with MHT duration in current and increased in past users ( p het = 0.015). Mortality due to causes other than BC and overall mortality were also reduced in current MHT users (HR 0.51, 95% CI 0.32–0.81, HR 0.66, 95% CI 0.52–0.86, respectively). Favorable tumor characteristics and mammographic surveillance could not fully explain associations of current MHT use with BCM and recurrence risk. Thus, the study contributes to the evidence that prediagnostic MHT does not have a negative impact on prognosis after BC. The restriction of a reduced BCM to low grade tumors should be confirmed in independent studies.