Menopausal hormone therapy after breast cancer: a meta-analysis and critical appraisal of the evidenceReport as inadecuate




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Breast Cancer Research

, 7:R535

First Online: 19 May 2005Received: 03 February 2005Revised: 06 April 2005Accepted: 08 April 2005

Abstract

IntroductionMenopausal hormone therapy HT is typically withheld from breast cancer survivors because of concerns about risk for recurrence. Our objectives were to estimate the effects of HT on recurrence in breast cancer survivors and to examine the reliability of these estimates.

MethodsIn a systematic review of the literature we identified all reports of HT use in breast cancer survivors that included comparison groups. Study design features that might affect selection of participants, detection of recurrence, and manuscript publication were assessed. The relative risks for breast cancer recurrence associated with HT were combined with random effects models.

ResultsTwo randomized and eight observational studies included 1,316 breast cancer survivors who used HT and 2,839 nonusers. In the observational studies, HT users were younger and more commonly node negative; only two reported balanced restaging for HT and control groups. Randomized trials suggest that HT increased the risk for recurrence relative risk 3.41, 95% confidence interval 1.59–7.33, whereas observational studies suggest that HT decreased this risk relative risk 0.64, 95% confidence interval 0.50–0.82.

ConclusionResults from observational studies of HT conducted in breast cancer survivors are discrepant with results from randomized trials. Observational studies of HT use in breast cancer survivors have design limitations that cannot be controlled for using standard statistical methods. Therefore, the randomized clinical trial data provide the only reliable estimates of the effect of HT use on recurrence risks in breast cancer survivors.

AbbreviationsCIconfidence interval

DFIdisease-free interval

HThormone therapy

RRrelative risk.

Electronic supplementary materialThe online version of this article doi:10.1186-bcr1035 contains supplementary material, which is available to authorized users.

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Author: Nananda F Col - Jung A Kim - Rowan T Chlebowski

Source: https://link.springer.com/



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