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Progestins and breast cancer
Title:Menopausal estrogen and estrogen-progestin replacement therapy and breast cancer risk
Author: C. Schairer, et al.
Address: Rockville, MD
Source:JAMA 283: 485-491 (January) 2000
Summary: A total of 46,355 postmenopausal women were studied to determine if the increased risk of breast cancer associated with the estrogen-progestin regimen is greater than those associated with estrogen alone. The average age of participants was 58 years and the average length of follow-up was 10.2 years. During the time period studied, 2082 cases of breast cancer were identified. Increases in risk with estrogen only and estrogen-progestin only were restricted to use within the previous 4 years with relative risk (RR) 1.2 for estrogen only and 1.4 for estrogen-progestin only. The RR increased by 0.01 with each year of estrogen only use and by 0.08 with each year of estrogen-progestin. Risk in heavier women did not increase with use of estrogen only or estrogen-progestin only. Researchers concluded that their data indicated that the estrogen-progestin regimen increases breast cancer risk beyond that associated with estrogen alone.
Comment: A relative risk of 1 suggests that there is neither an increase nor decrease in an event happening. A RR of 1.2 indicates a 20% increase, or in this study, from about 4% to about a 5% chance of developing breast cancer. Most studies thus far have hovered around RR of 1, most very slightly above 1. In evaluating the value of estrogen replacement, a useful comparison is that there are 4 times as many women who die as a result of a hip fracture than breast cancer. The above adds data, still total benefit versus total risk should be considered.