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Effect of the use of prediagnosis hormones on breast cancer prognosis: MCC-Spain study. Menopause 2022; 29:1315-1322. [PMID: 36256924 DOI: 10.1097/gme.0000000000002069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To extend knowledge about the long-term use of hormones in hormone therapy or oral contraception as prognostic factors in breast cancer. METHODS The MCC-Spain project is a cohort of 1,685 women with incident breast cancer recruited in Spain. Recruitment was carried out between 2007 and 2010, and the follow-up finished in December 2017. The impact of hormone therapy or oral contraception on breast cancer prognosis was analyzed considering year of birth and menopausal status (1,095 women [65%] were postmenopausal). Hazard ratios (HRs) were estimated using Cox regression models. Death by any cause was considered as the event, and hormone therapy or oral contraception were analyzed as regressors. RESULTS Oral contraception use for less than 5 years shows an HR of 1.10 (95% CI, 0.75 to 1.62), whereas use for 5 or more years shows an HR of 1.46 (95% CI, 0.95 to 2.25), with a P trend of 0.01, showing a dose-dependent response. Regarding hormone therapy and restricting the analysis to postmenopausal women born between1940 and 1959, where most hormone therapy (consumption) is concentrated, the results did not show any trend. CONCLUSION Concerning oral contraception use, our results demonstrate that their use is related to poor prognosis in breast cancer. However, research in this field is limited and controversial, indicating the need for more research in this area. Regarding hormone therapy consumption, our results indicate no association with better prognosis, which contradicts what has previously been published.
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Tarlan M, Khazaei S, Madani SH, Saleh E. Prognostic factors for cancer-specific survival in 220 patients with breast cancer: A single center experience. Cancer Rep (Hoboken) 2022; 6:e1675. [PMID: 35931659 PMCID: PMC9875637 DOI: 10.1002/cnr2.1675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 05/31/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Hospital-based breast cancer survival studies are scarce in western Iran. Furthermore, the relationship between breast cancer survival and clinical parameters has been extensively studied, but many of the findings come from developing countries. This paper aims to estimate the survival of hospital-based breast cancer patients and its predictor factors. METHOD This retrospective analysis was conducted on 578 patients with primary breast cancer who underwent surgery between 2004 and 2020. Information was collected from medical reports by the Hospital information system in Imam Reza Hospital, Kermanshah, Iran. One-, 2-, 5-, and 10-year breast cancer-specific survival has been calculated using the Kaplan-Meier process. Crude and adjusted Hazard Ratios (HR) were calculated using the Cox proportional regression model. RESULT One-, 2-, and 5-year overall breast cancer survival were 219 (99.54%), 196 (89.09%), 159 (72.27%), and 70 (31.81%), respectively. Univariate analysis of breast cancer patients with tumor-related variables revealed that factors such as age, menopause status, lymph node metastasis, number of lymph nodes, organ metastasis, and stage of disease were significantly associated with disease-specific survival (p < .05). Multivariate analysis demonstrated that metastasis (HR = 41.77, 95% CI: 15.3-114.15) and lymph node metastasis (HR = 5.26, 95% CI: 1.9-14.6) were significantly related to survival. CONCLUSION The findings demonstrate that survival is relatively low and is consistent with late-stage disease diagnosis. It is believed that this is due to a poor level of awareness, lack of screening programs, and subsequent late access to treatment.
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Affiliation(s)
- Mitra Tarlan
- Clinical Research Development Center, Imam Reza HospitalKermanshah University of Medical SciencesKermanshahIran
| | - Sedigheh Khazaei
- Clinical Research Development Center, Imam Reza HospitalKermanshah University of Medical SciencesKermanshahIran
| | - Seyed Hamid Madani
- Molecular Pathology Research CenterImam Reza Hospital, Kermanshah Universitiy of Medical ScienceKermanshahIran
| | - Elaheh Saleh
- Department of Health Education and Health Promotion, Faculty of HealthSemnan University of Medical ScienceSemnanIran
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Huzell L, Persson M, Simonsson M, Markkula A, Ingvar C, Rose C, Jernström H. History of oral contraceptive use in breast cancer patients: impact on prognosis and endocrine treatment response. Breast Cancer Res Treat 2015; 149:505-15. [DOI: 10.1007/s10549-014-3252-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 12/17/2014] [Indexed: 01/01/2023]
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Lu Y, Ma H, Malone KE, Norman SA, Sullivan-Halley J, Strom BL, Simon MS, Marchbanks PA, McDonald JA, West DW, Henderson KD, Deapen D, Ursin G, Bernstein L. Oral contraceptive use and survival in women with invasive breast cancer. Cancer Epidemiol Biomarkers Prev 2011; 20:1391-7. [PMID: 21551244 PMCID: PMC3132273 DOI: 10.1158/1055-9965.epi-11-0022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Oral contraceptives (OC) are widely used in the United States. Although the relation between OC use and breast cancer incidence has been widely studied, the few studies examining associations between OC use prior to breast cancer diagnosis and survival are inconsistent. METHODS Women with invasive breast cancer participating in the Women's Contraceptive and Reproductive Experiences (CARE) Study, a population-based case-control study (4565 women ages 35-64 years), and the California Teachers Study (CTS) cohort (3929 women ages 28-91 years) were followed for vital status. A total of 1,064 women died in the CARE Study (median follow-up, 8.6 years) and 523 died in the CTS (median follow-up, 6.1 years). Cox proportional hazards regression provided hazard rate ratio estimates [(relative risk, RR)] with 95% confidence intervals (CIs) for risk of death from any cause and from breast cancer. RESULTS No association was observed for any OC use prior to diagnosis and all-cause mortality [CARE Study: RR = 1.01 (95% CI = 0.86-1.19); CTS: RR = 0.84 (95% CI = 0.67-1.05)]. A decreased risk of all-cause mortality was observed in the CTS among women with more than 10 years of OC use (RR = 0.67, 95% CI = 0.47-0.96); however, no trend of decreasing risk with increasing OC duration was observed (P(trend) = 0.22), and no association was observed in the CARE study. No associations were observed for breast cancer-specific mortality. CONCLUSIONS OC use is not associated with all-cause or breast cancer-specific mortality among women with invasive breast cancer. IMPACT These 2 independent studies demonstrated no overall association between OC use and survival among women with breast cancer.
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Affiliation(s)
- Yani Lu
- Division of Cancer Etiology, Department of Population Sciences, City of Hope National Medical Center, Duarte, CA 91010, USA.
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Bernardi CC, Ribeiro EDSF, Cavalli IJ, Chautard-Freire-Maia EA, Souza RLR. Amplification and deletion of the ACHE and BCHE cholinesterase genes in sporadic breast cancer. ACTA ACUST UNITED AC 2010; 197:158-65. [PMID: 20193849 DOI: 10.1016/j.cancergencyto.2009.10.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 09/22/2009] [Accepted: 10/17/2009] [Indexed: 01/11/2023]
Abstract
Increasing evidence supports the involvement of acetylcholinesterase and butyrylcholinesterase in cell proliferation control and differentiation, reinforcing the hypothesis that these enzymes might have an influence in tumorigenesis. It has already been shown that the cholinesterase genes are structurally altered or aberrantly expressed in a variety of tumor types. In this study, amplifications and deletions in the ACHE and BCHE genes were investigated in sporadic breast tumors using real-time polymerase chain reaction and the relative quantification method. The majority of the tumor tissues showed a notable number of both deletions and amplifications: 65.7% and 22.9%, respectively, in BCHE and 45.7% and 31.4%, respectively, in ACHE. Deletion of the ACHE gene was significantly correlated with amplification of the protooncogene ERBB2. Tumor size was significantly higher when the ACHE gene was amplified, and the total number of alterations (amplifications plus deletions) of the BCHE gene was positively correlated with tumor malignancy grade.
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Affiliation(s)
- Caroline C Bernardi
- Department of Genetics, Federal University of Paraná, P.O. Box 19071, CEP 81531-990, Curitiba, PR, Brazil
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Phillips KA, Milne RL, West DW, Goodwin PJ, Giles GG, Chang ET, Figueiredo JC, Friedlander ML, Keegan THM, Glendon G, Apicella C, O'Malley FP, Southey MC, Andrulis IL, John EM, Hopper JL. Prediagnosis reproductive factors and all-cause mortality for women with breast cancer in the breast cancer family registry. Cancer Epidemiol Biomarkers Prev 2009; 18:1792-7. [PMID: 19505912 DOI: 10.1158/1055-9965.epi-08-1014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Studies have examined the prognostic relevance of reproductive factors before breast cancer diagnosis, but most have been small and their overall findings inconclusive. Associations between reproductive risk factors and all-cause mortality after breast cancer diagnosis were assessed with the use of a population-based cohort of 3,107 women of White European ancestry with invasive breast cancer (1,130 from Melbourne and Sydney, Australia; 1,441 from Ontario, Canada; and 536 from Northern California, United States). During follow-up with a median of 8.5 years, 567 deaths occurred. At recruitment, questionnaire data were collected on oral contraceptive use, number of full-term pregnancies, age at first full-term pregnancy, time from last full-term pregnancy to breast cancer diagnosis, breastfeeding, age at menarche, and menopause and menopausal status at breast cancer diagnosis. Hazard ratios for all-cause mortality were estimated with the use of Cox proportional hazards models with and without adjustment for age at diagnosis, study center, education, and body mass index. Compared with nulliparous women, those who had a child up to 2 years, or between 2 and 5 years, before their breast cancer diagnosis were more likely to die. The unadjusted hazard ratio estimates were 2.75 [95% confidence interval (95% CI), 1.98-3.83; P < 0.001] and 2.20 (95% CI, 1.65-2.94; P < 0.001), respectively, and the adjusted estimates were 2.25 (95% CI, 1.59-3.18; P < 0.001) and 1.82 (95% CI, 1.35-2.46; P < 0.001), respectively. When evaluating the prognosis of women recently diagnosed with breast cancer, the time since last full-term pregnancy should be routinely considered along with other established host and tumor prognostic factors, but consideration of other reproductive factors may not be warranted.
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Affiliation(s)
- Kelly-Anne Phillips
- Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Barnett GC, Shah M, Redman K, Easton DF, Ponder BAJ, Pharoah PDP. Risk factors for the incidence of breast cancer: do they affect survival from the disease? J Clin Oncol 2008; 26:3310-6. [PMID: 18612147 DOI: 10.1200/jco.2006.10.3168] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Risk factors that influence the incidence of breast cancer may also affect survival after diagnosis. METHODS Data from 4,560 women with invasive breast cancer who had taken part in the population-based Studies of Epidemiology and Risk Factors in Cancer Heredity (SEARCH) breast cancer study were used to investigate the influence on survival of variables related to pregnancy, menarche and menopause, prior use of exogenous hormones, height, weight, body mass index (BMI), smoking history, and alcohol intake. RESULTS In univariate analyses, there was no association between prognosis and age at menarche and menopause, menopausal status at diagnosis, smoking history, or prior use of the oral contraceptive pill. Women whose most recent pregnancy was more than 30 years ago had a 35% reduced risk of dying (95% CI, 8% to 54%) compared with women who had a full-term pregnancy in the past 15 years, and the use of hormone replacement therapy for more than 4 years was associated with a similar risk reduction. BMI was associated with a 3% (95% CI, 1% to 4%) increase in mortality per unit increase. Improved prognosis was seen with increasing current alcohol consumption, with a 2% (95% CI, 1% to 3%) reduction in the risk of death per unit of alcohol consumed per week. CONCLUSION The apparent benefit of alcohol intake has not been described before, and our data need to be interpreted with some caution. However, our finding that an increase in BMI is associated with a poorer prognosis supports previously published data and suggests that advice on weight loss should be given to all obese patients with breast cancer.
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Affiliation(s)
- Gillian C Barnett
- Oncology Centre, Box 193, Addenbrooke's Hospital, Hills Rd, Cambridge, CB2 2QQ, United Kingdom.
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Veneroso C, Siegel R, Levine PH. Early age at first childbirth associated with advanced tumor grade in breast cancer. ACTA ACUST UNITED AC 2008; 32:215-23. [DOI: 10.1016/j.cdp.2008.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2008] [Indexed: 10/21/2022]
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Wingo PA, Austin H, Marchbanks PA, Whiteman MK, Hsia J, Mandel MG, Peterson HB, Ory HW. Oral Contraceptives and the Risk of Death From Breast Cancer. Obstet Gynecol 2007; 110:793-800. [PMID: 17906011 DOI: 10.1097/01.aog.0000284446.22251.6e] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the relationship between the use of oral contraceptives and the risk of death from breast cancer. METHODS We used interview data from the Cancer and Steroid Hormone Study, linked to cancer registry data from the Surveillance, Epidemiology, and End Results Program, to examine the 15-year survival and prior use of oral contraceptives among 4,292 women aged 20 to 54 years when diagnosed with breast cancer from December 1, 1980, to December 31, 1982. Cox proportional hazard models were used to estimate the relative rate of death from breast cancer by oral contraceptive use. RESULTS Duration of oral contraceptive use, time since first use, age at first use, and use of specific pill formulations were not associated with survival. For time since last use, the risk of death from breast cancer decreased significantly with increasing time since last use of oral contraceptives, but a consistent gradient effect was not observed. Adjusted hazard ratios ranged from 0.86 to 1.41 and were 1.00 or less for all recency categories except during 13 to 24 months before diagnosis; none was statistically significant. Women who were currently using oral contraceptives had an adjusted hazard ratio of 0.90 (0.68, 1.19). CONCLUSION Overall, oral contraceptive use had neither a harmful nor a beneficial effect on breast cancer mortality. The differences between pill users and nonusers were slight, and the risk estimates were usually reduced with confidence limits that nearly always included 1.0.
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Affiliation(s)
- Phyllis A Wingo
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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10
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Trivers KF, Gammon MD, Abrahamson PE, Lund MJ, Flagg EW, Moorman PG, Kaufman JS, Cai J, Porter PL, Brinton LA, Eley JW, Coates RJ. Oral Contraceptives and Survival in Breast Cancer Patients Aged 20 to 54 Years. Cancer Epidemiol Biomarkers Prev 2007; 16:1822-7. [PMID: 17855700 DOI: 10.1158/1055-9965.epi-07-0053] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Recent oral contraceptive (OC) use is associated with modestly higher breast cancer incidence among younger women, but its impact on survival is unclear. This study examined the relationship between OC use before breast cancer diagnosis and survival. A population-based sample of 1,264 women aged 20 to 54 years with a first primary invasive breast cancer during 1990 to 1992 were followed up for 8 to 10 years. OC and covariate data were obtained by interviews conducted shortly after diagnosis and from medial records. All-cause mortality was ascertained through the National Death Index (n = 292 deaths). Age- and income-adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated by Cox regression methods. All-cause mortality was not associated with ever use of OCs or duration of use. Compared with nonusers, mortality estimates were elevated among women who were using OCs at diagnosis or stopped use in the previous year (HR, 1.57; 95% CI, 0.95-2.61). The HR for use of high-dose estrogen pills within 5 years before diagnosis was double that of nonusers (HR, 2.39; 95% CI, 1.29-4.41) or, if the most recent pill included the progestin levonorgestrel, compared with nonusers (HR, 2.01; 95% CI, 1.03-3.91). Because subgroup estimates were based on small numbers of OC users, these results should be cautiously interpreted. Overall, most aspects of OC use did not seem to influence survival, although there is limited evidence that OC use just before diagnosis, particularly use of some pill types, may negatively impact survival in breast cancer patients aged 20 to 54 years.
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Affiliation(s)
- Katrina F Trivers
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS K-52, Atlanta, GA 30341, USA.
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DiSaia PJ, Brewster WR. Hormone replacement therapy for survivors of breast and endometrial cancer. Curr Oncol Rep 2002; 4:152-8. [PMID: 11822987 DOI: 10.1007/s11912-002-0076-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Indirect evidence suggests that endogenous and exogenous estrogen does not influence the outcome of patients treated for breast or endometrial cancer. However, many reports have affirmed beneficial effects of hormone replacement therapy (HRT) in preventing multiple disease states and improving the quality of life of individual patients. Every practitioner of urogynecology understands the benefits of local and systemic therapy to women who suffer from urinary incontinence and/or loss of pelvic floor support. Thus, it seems appropriate to suggest that survivors of breast or endometrial cancer who request information on HRT for relief of their menopausal symptoms and for other benefits, of which patients are becoming increasingly aware, deserve a comprehensive explanation.
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Affiliation(s)
- Philip J DiSaia
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of California Irvine Medical Center, Chao Clinical Cancer Center, 101 The City Drive South, Orange, CA 92867, USA.
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Reeves GK, Patterson J, Vessey MP, Yeates D, Jones L. Hormonal and other factors in relation to survival among breast cancer patients. Int J Cancer 2000; 89:293-9. [PMID: 10861507 DOI: 10.1002/1097-0215(20000520)89:3<293::aid-ijc13>3.0.co;2-r] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We have examined the relationship between all-cause mortality and various hormonal and other factors in over 1,200 women with breast cancer recruited into 2 consecutive case-control studies between 1969 and 1984. The age at diagnosis ranged from 24 to 59 years, and the majority (74%) were pre-menopausal at diagnosis. Analyses were based on follow-up to 1 January 1994, by which time 608 (50%) of the women had died. Of the factors examined, weight was most strongly associated with survival, with a significant increase in the risk of death with increasing weight. Two hormonal factors, time since last birth and time since last oral contraceptive use, were also independently associated with survival. All of these associations remained after adjustment for stage and histological nodal status. Our findings provide new evidence to suggest that reproductive factors and exogenous hormones in the form of oral contraceptives may influence survival in women with breast cancer, even after differences in stage and nodal status have been taken into account.
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Affiliation(s)
- G K Reeves
- Cancer Epidemiology Unit, Imperial Cancer Research Fund, Radcliffe Infirmary, Oxford, UK.
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Sauerbrei W, Blettner M, Schmoor C, Bojar H, Schumacher M. The effect of oral contraceptive use on the prognosis of node positive breast cancer patients. German Breast Cancer Study Group. Eur J Cancer 1998; 34:1348-51. [PMID: 9849415 DOI: 10.1016/s0959-8049(98)00139-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The effect of oral contraceptive (OC) use as a risk factor for breast cancer was recently assessed in a large meta-analysis, but currently available data on the prognostic effect are still insufficient. We investigated the relationship between OC use and standard prognostic factors and the effect of OC use on recurrence-free survival (RFS) and overall survival (OS) in 422 premenopausal pT1a-3aN + M0 patients from two trials of the German Breast Cancer Study Group (GBSG). 137 patients (32.5%) were OC users. They were younger on average (mean age 41.5 years versus 45 years for non-OC users) and the percentage of patients with smaller tumours was higher in the group of OC users. Based on 163 events for RFS and 103 events for OS, no significant effect of OC use on RFS and OS could be demonstrated in univariate and multivariate analyses. In our study of node positive breast cancer cases, OC users were younger and had smaller tumours. This may be an effect of earlier detection of breast cancer, but OC users did not have a better prognosis, both before and after adjustment for tumour size and other prognostic factors.
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Affiliation(s)
- W Sauerbrei
- Institute of Medical Biometry and Informatics, Albert-Ludwigs-University, Freiburg, Germany
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Schouten LJ, Hupperets PS, Jager JJ, Volovics L, Wils JA, Verbeek AL, Blijham GH. Prognostic significance of etiological risk factors in early breast cancer. Breast Cancer Res Treat 1997; 43:217-23. [PMID: 9150901 DOI: 10.1023/a:1005790531122] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Several risk factors for the etiology of breast cancer have also been correlated with the prognosis of breast cancer. However, the published studies have yielded conflicting results. Women under 71 years of age with stage I, II, or III breast cancer were eligible for inclusion in a clinical study. 866 patients with breast cancer entered the study, of whom 463 had positive lymph nodes. Survival was analysed using Cox's proportional hazards model. Age at menarche parity, age at menopause and family history were not consistently related to survival. Young age at first full-term pregnancy was related to decreased survival (adjusted relative risk (RR): 1.69, 95% confidence intervals (95% CI): 1.04-2.68), but it cannot be excluded that this result was due to chance alone. Use of oral contraceptives was not correlated with survival (RR: 1.10, 95% CI: 0.80-1.51) nor was family history (RR: 0.93, 95% CI: 0.66-1.30). This study provided little support for the hypothesis that risk factors for breast cancer are related to survival.
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Affiliation(s)
- L J Schouten
- Department of Cancer Registration, Comprehensive Cancer Centre IKL, Maastricht, The Netherlands
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15
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Vassilopoulou-Sellin R, Theriault R, Klein MJ. Estrogen replacement therapy in women with prior diagnosis and treatment for breast cancer. Gynecol Oncol 1997; 65:89-93. [PMID: 9103397 DOI: 10.1006/gyno.1997.4621] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We followed 49 women who underwent a minimum of 2 years estrogen replacement therapy (ERT) after diagnosis and treatment for localized breast cancer. Forty-three women were treated with oral ERT. In this group, the median age at the time of cancer diagnosis was 46 years (range 26 to 66 years), and ERT was begun a median of 84 months after diagnosis (range 0 to 286 months). The patients were followed for a median of 144 months after cancer diagnosis (range 46 to 324 months), and the median duration of ERT was 31 months (range 24 to 142 months). For six women, ERT was administered as a vaginal cream application. In this group, the median age at time of cancer diagnosis was 46 years (range 38 to 57 years), and ERT was begun a median of 49 months after diagnosis (range 24 to 61 months). The patients were followed for a median of 95 months after cancer diagnosis (range 72 to 154 months), and the median duration of ERT was 47 months (range 27 to 80 months). One patient experienced disease recurrence; she had received surgery for a stage I, estrogen receptor (ER)-positive lesion. The patient began ERT 30 months after cancer diagnosis and developed a recurrent ER-negative tumor 56 months after initiation of ERT. She remained alive without evidence of disease for 10 years since initial diagnosis of breast cancer. Despite the inherent limitations of retrospective experiential data and the need for prospective, randomized trials to assess the safety of ERT, the present observations suggest that ERT does not appear to have a pronounced adverse effect on cancer outcome. Nevertheless, until appropriate clinical trials determine that ERT is safe, caution is needed.
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Affiliation(s)
- R Vassilopoulou-Sellin
- Section of Endocrinology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA
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