Arch Intern Med. Background Epidemiologic studies, largely of white women, have found that recent long-term female hormone use, particularly use of estrogen with progestin, is associated with an increased risk of breast cancer.
Some studies suggest that the increase is greater among leaner women. Our aim was to assess the relation of female hormone use to incidence of breast cancer in black women, with attention to differences in effect according to body mass index.
Methods Data on female hormone use, breast cancer risk factors, and the occurrence of breast cancer were collected through biennial questionnaires from through in the Black Women's Health Study, a follow-up study of US black women.
During person-years of follow-up of 32 women 40 years or older, cases Hampshire dating profiles breast cancer were reported. The incidence rate ratio for breast cancer in women recently using female hormone supplements relative to those who had never used female hormones, with control for confounding factors, increased with duration of use and was 1.
Among the leaner women who recently used female hormone supplements for durations of 10 or more years, the incidence rate ratio was 3. Conclusion These based on data from US black women strengthen the evidence that use of estrogen alone and estrogen with progestin increases the risk of breast cancer and that the association is stronger among leaner women.
Many observational sex dates Cleveland Ohio OH suggest that the risk of breast cancer is increased by the long-term use of female hormone supplements, particularly the use of estrogen with progestin; the associations have been strongest for recent use, variously defined as current use or use within the 1 to 5 years. Breast cancer risk was not increased among women using estrogen alone in the WHI. Belief that an association represents cause and effect is strengthened when similar are obtained across different populations.
Black women take female hormone supplements less frequently compared with white women, and the distribution of risk factors Sunnyvale CA dating nigerian breast cancer also differs between these ethnic groups. A case-control study that included black women with breast cancer reported that continuous use of combined estrogen and progestin was associated with an increased risk of breast cancer for all ethnic groups combined and that the association was not ificantly modified by ethnic group.
Some studies have found that the association of female hormone use with breast cancer risk differs according to body mass index BMI; calculated as weight in kilograms divided by the square of height in meterswith greater increases in breast cancer risk for leaner female hormone users. Female hormone use declined dramatically after the release of the WHI23 and selective changes in use associated with breast cancer risk could lead to bias in future observational studies.
Therefore, we assessed the relation of female hormone use to breast cancer incidence in the BWHS using female hormone data collected before the WHI were published. The BWHS began inwhen 64 Simpsonville hookups women aged 21 to 69 years were enrolled through postal health questionnaires.
Most hookup places Irving the enrollees were subscribers to Essence magazine, a popular magazine targeted to black women, and small s were members of selected professional organizations or friends or relatives of early respondents. The 59 participants whose addresses were judged to be valid 1 year after entry have been followed through biennial postal questionnaires. The baseline questionnaire included questions about the use of female hormones recency of use, duration, and type of preparation last usedmenopausal status, and medical history.
The follow-up questionnaires asked about these factors and the occurrence of breast cancer in the 2 years. The present analyses used data from baseline in through the follow-up cycle. Review of medical records of incident cases of breast cancer for validation of self-report is an ongoing process in the BWHS. The 3 unconfirmed cases were excluded. Female hormone use and menopausal status among women who consented to release their records were similar to those among women who refused, allaying concern that speed dating Newport americans willingness to release their records was associated with female hormone use.
We defined recent use of female hormones as use within the 2 years of any oral medications or patches containing female hormones and past use as use that had ceased more than 2 years ly. Breast cancer occurring in a particular follow-up cycle was assessed in relation to exposure data from the cycle eg, breast cancer reported on the questionnaire in relation to female hormone use reported on the questionnaire. Women contributed person-years of female hormone use or nonuse during each follow-up cycle.
Over the Norfolk VA women dating asian men of follow-up, a woman could contribute person-years of use of estrogen alone, estrogen with progestin, progestin alone, and nonuse. After excluding women who had breast cancer at baseline, were currently taking Merced laws on dating a contraceptives, had unknown menopausal status, or did not complete the female hormone questions, 32 women were followed up for breast cancer incidence.
Because women younger than 40 years rarely take female hormone date native San Francisco CA women, the analysis was confined to women 40 years or older at baseline 23 women or who reached age 40 years during follow-up women. We used age-stratified Cox regression models SAS version 8.
Women contributed person-years from baseline to the time of diagnosis of breast cancer, loss to follow-up, death, or the dating services Oceanside CA of follow-up Marchwhichever came first. The Anderson-Gill data structure was used to dating in cork Medford time-varying covariates.
As shown in Table 1among 23 women 40 years or older at baseline, female hormone use best Tacoma WA to meet women associated positively with being postmenopausal particularly because of bilateral oophorectomymenopause before age 50 years, menarche at 14 years or older, benign breast disease, living in the West, and having had a mammogram in the 2 years. We controlled for menopausal status premenopausal, naturally menopausal, bilateral oophorectomy, and hysterectomy and age at menopause in the final Cox regression models; for women with a simple hysterectomy hysterectomy without removal of both ovariesthe age at hysterectomy was used as the age at menopause.
We carried out a secondary analysis confined to women who had not had a simple hysterectomy ie, premenopausal women and women who were postmenopausal owing to bilateral oophorectomy or natural causes.
Information on the use Pittsburgh Pennsylvania PA dating agency mammography in the 2 years was obtained on each follow-up questionnaire. To assess whether having undergone mammography affected the association between female hormone use and breast cancer risk, we conducted a secondary analysis that excluded noncases who had not had a mammogram in the 2 years.
During person-years of follow-up of 23 BWHS participants during throughcases of breast cancer were reported Table 2. The IRR point estimate was greater for recent 1. The IRR increased with increasing duration of recent female hormone use and was 1.
There were too few date with Binghamton of progestin alone for informative on this hormone. The were closely similar when we excluded women who had not had a mammogram in the 2 years data not shown.
Among the leanest women, the IRR was 1. The IRR for recent users increased with duration of use and was 3. We examined IRRs among strata of other risk factors for breast cancer, including alcohol consumption, benign breast disease, parity, and oral contraceptive use.
Original research article
The associations of female hormone use with breast cancer risk did not vary materially across strata of these factors, but strata-specific s of users tended to be small. s were too small to assess modification by family history of breast cancer.
To assess whether the association of female hormone use with breast cancer risk was consistent across socioeconomic strata, we examined IRRs among subgroups of educational attainment. The IRRs were similar across the strata: for 10 or more years of recent group dating Lexington hormone NJ workers dating, the IRR estimates among women sex meetings Chesapeake VA 12 or less, 13 to 15, and 16 or more years of education were 1.
Because it is not possible to accurately determine and fully control age at menopause for women with a simple hysterectomy, 27 we carried out a secondary analysis among the 26 women remaining after exclusion of those women.
The were closely similar to those presented. The present suggest that recent long-term female hormone use increases the risk of breast cancer among US black women. The findings apply to female hormone pills, which ed for most of the use among women in free dating girl in Yonkers BWHS. In a large British follow-up study, the Million Women Study, the relative risks did not differ between those taking oral and transdermal estrogen supplements. In the present study, risk of breast cancer increased with increasing duration of female hormone use; the overall IRR was 1.
Most studies, largely of white women, have found an increased risk of breast cancer associated with use of estrogen with progestin and that risk increases with duration of use. Many observational studies have reported an adverse effect of use of estrogen alone on breast cancer risk. In the combined analysis of more than 50 cases 2 and in the Million Women Study, 4 the relative risks for use of estrogen alone for 5 or more man looking for woman Appleton WI were both 1.
In the follow-up study by Kerlikowske et al 29 of women who underwent mammography examinations from to Chandler geek dating, although the relative risk was ificantly increased for women who used estrogen with progestin for 5 years or more, the corresponding estimate for those using estrogen alone for 5 years or more was decreased 0.
However, this study is likely to have underestimated an adverse effect of estrogen alone, as well as of estrogen with progestin, because age at menopause was not controlled 227 ; younger age at menopause is strongly inversely associated with breast cancer risk and positively associated with female hormone use, and allowance for it increases the risk estimates for those taking female hormone supplements.
In contrast to the observationalthere was no increase in the risk of breast cancer among women using estrogen in the WHI; indeed, the hazard ratio was 0. The present finding that associations were strongest among the leaner women agrees with observational .
However, the P value for interaction was. Associations of exogenous female hormone use with increased risk of breast cancer are biologically plausible. Endogenous estrogens are associated with increased risk of breast cancer. The production of estrogen from adipose tissue is greater among heavier postmenopausal women compared with leaner white 31 ; therefore, exogenous estrogens may have less of an effect on estrogen levels in heavier women, perhaps explaining the stronger association with female hormone supplement use in leaner women. Moreover, female hormone use and other important characteristics at baseline, such as menopausal status, of women who completed the final follow-up questionnaire in the period analyzed in the Cary report women women who did not were similar; free phone chat line numbers Los Angeles CA suggests the absence of Corona CA i dating a loser losses.
The women reported their mammography use on each of the biennial follow-up questionnaires, and high proportions had undergone mammography. Thus, greater detection of breast cancer among those taking female hormone supplements due to greater medical surveillance is unlikely to explain the findings, particularly because changed little when women who did not have a recent mammogram were excluded from dating in the Dallas Tx east analysis. The exposure data were collected prospectively, thereby eliminating reporting bias.
Because the exposure data were collected before the release of the of the WHI, 15 changes in female hormone use in response to those findings cannot explain our. Misclassification of use of meet ladies in Amarillo TX taken with progestin as use of estrogen alone, and vice versa, would have resulted in overestimation of an effect of estrogen alone and underestimation of men effect of estrogen Trenton phone chat lines free trials progestin.
Misclassification of breast cancer cases was unlikely to have affected the because self-report was accurate among the black confirmed by medical records; in addition, the cases confirmed with medical records were similar to those for whom records were not obtained. However, the obtainment of medical records for only half of the cases in the present analyses made it infeasible to assess the effect of female hormone use according to factors such as the stage of the cancer or estrogen receptor status.
Some observational data suggest that female hormone use is associated with early-stage breast cancer, 4 but the use of estrogen with progestin was associated with more advanced stages of breast cancer in the WHI. The present were consistent across strata of education. In summary, the present findings based on data from US black women strengthen the evidence that use of female hormone supplements increases the risk of breast cancer.
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Table 1. View Large Download. Collaborative Group on Hormonal Factors in Breast Cancer, Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52, women with breast cancer andwomen without breast cancer. La Vecchia C Estrogen and combined estrogen-progestogen therapy in the menopause and breast cancer. Breast cancer risk following long-term estrogen and estrogen-progestin-replacement therapy. Kirsh VKreiger N Estrogen and estrogen-progestin replacement therapy and risk of Topeka born chinese dating breast cancer in Canada.
Hormone replacement therapies and breast cancer risk. Estrogen-progestin replacement therapy and breast cancer risk: the Women's Health Study United States. Relationship between long durations and different regimens of hormone therapy and risk of breast cancer. Increased risk of breast cancer following different regimens of hormone replacement therapy frequently used in Europe.
Writing Group for the Women's Health Initiative Investigators, Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal from the Women's Health Initiative randomized controlled trial.
Women's Health Initiative Steering Committee, Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial. Breast cancer in a multiethnic cohort in Hawaii and Los Angeles: risk dating service Collins MS ma incidence in Japanese equals and in Hawaiians exceeds that in whites.