Hormone replacement therapy and breast cancer: A qualitative review

OBJECTIVE: To assess whether recent epidemiologic evidence supports an association between use of estrogen replacement therapy or hormone replacement therapy and risk of breast cancer. DATA SOURCES: The keywords "estrogen," "estrogen replacement therapy," or "hormone replacement therapy," and "breast cancer" or "breast neoplasm," were used to search for articles published from 1975-2000 in MEDLINE and Dialogweb. Only articles published in peer-reviewed journals and containing original data were included in this review. METHODS: Unadjusted or age-adjusted risk estimates for breast cancer among ever users of estrogen therapy compared with never users were abstracted from published articles or calculated using the data provided in the published reports. TABULATION, INTEGRATION, AND RESULTS: We found little consistency among studies that estimated the risk of breast cancer in hormone users compared with nonusers and in studies assessing the risk by duration of use. However, there was consistently a lower risk of death from breast cancer in hormone users compared with nonusers. CONCLUSION: The evidence did not support the hypotheses that estrogen use increases the risk of breast cancer and that combined hormone therapy increases the risk more than estrogen only. Additional observational studies are unlikely to alter this conclusion. Although a small increase in breast cancer risk with hormone therapy or an increased risk with long duration of use (15 years or more) cannot be ruled out, the likelihood of this must be small, given the large number of studies conducted to date. (C) 2001 by the American College of Obstetricians and Gynecologists.