Does Hormone Therapy Formulation Impact Breast Cancer Risk?
BACKGROUND AND PURPOSE:
Abenhaim et al. (Obstetrics & Gynecology, 2022) evaluated whether the increased risk of breast cancer is dependent on the formulation of menopausal hormone therapy (HT) used
Population-based case-control study
UK Clinical Practice Research Datalink
Computerized database | Longitudinal records from primary care
Estimated 7.5% of the UK population (from 545 general practices)
Women ≥50 years
Registered in the database between January 1, 1995, and December 31, 2014
Ever or never for menopausal HT formulations
Incident breast cancer cases were age-matched (1:10) to controls with no history of breast cancer
Breast cancer identification: Validated algorithm using medical procedures, visits, or treatments
Logistic regression analyses used to estimate the adjusted effect of menopausal HT formulation on breast cancer risk
Covariate data collection: Obesity | Smoking | Alcohol consumption | Medical history of endometrial cancer, hysterectomy, oophorectomy, oral contraceptive use | Family history of breast cancer
Risk of breast cancer
Breast cancer cases: 43,183 | Controls: 431,830
Use of HT was associated with an increased risk of breast cancer
OR 1.12 (95% CI, 1.09 to 1.15)
Compared with never users, estrogens were not associated with breast cancer
OR 1.04 (95% CI, 1.00 to 1.09)
OR 1.01 (95% CI, 0.96 to 1.06)
Both bioidentical and animal-derived estrogens
OR 0.96 (95% CI, 0.89 to 1.03)
Progestogens appeared to be differentially associated with breast cancer
OR 0.99 (95% CI, 0.55 to 1.79)
OR 1.28 (95% CI, 1.22 to 1.35)
Both micronized and synthetic progestogens
OR 1.31 (95% CI, 0.30 to 5.73)
Menopausal HT is associated with a greater odds of breast cancer predominantly driven by synthetic progestin formulations
Estrogen was not associated with increased risk (biodentical or animal-derived)
The authors state
In light of our results, consideration should be given to discontinuing the use of synthetic progestin in menopausal HT regimens. Clinical practice guidelines should consider bioidentical progestogens as the agent of choice in menopausal HT regimens
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