Hormone replacement therapy after a diagnosis of breast cancer: cancer recurrence and mortality

Eva M Durna, Leo R Leader, Peter Sjoblom, John A Eden, Barry G Wren and Gillian Z Heller
Med J Aust 2002; 177 (7): 347-351.


Objective: To determine whether hormone replacement therapy (HRT) after treatment for breast cancer is associated with increased risk of recurrence and mortality.

Design: Retrospective observational study.

Participants and setting: Postmenopausal women diagnosed with breast cancer and treated by five Sydney doctors between 1964 and 1999.

Outcome measures: Times from diagnosis to cancer recurrence or new breast cancer, to death from all causes and to death from primary tumour were compared between women who used HRT for menopausal symptoms after diagnosis and those who did not. Relative risks (RRs) were determined from Cox regression analyses, adjusted for patient and tumour characteristics.

Results: 1122 women were followed up for 0–36 years (median, 6.08 years); 154 were lost to follow-up. 286 women used HRT for menopausal symptoms for up to 26 years (median, 1.75 years). Compared with non-users, HRT users had reduced risk of cancer recurrence (adjusted relative risk [RR], 0.62; 95% CI, 0.43–0.87), all-cause mortality (RR, 0.34; 95% CI, 0.19–0.59) and death from primary tumour (RR, 0.40; 95% CI, 0.22–0.72). Continuous combined HRT was associated with a reduced risk of death from primary tumour (RR, 0.32; 95% CI, 0.12–0.88) and all-cause mortality (RR, 0.27; 95% CI, 0.10–0.73).

Conclusion: HRT use for menopausal symptoms by women treated for primary invasive breast cancer is not associated with an increased risk of breast cancer recurrence or shortened life expectancy.

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  • Eva M Durna1
  • Leo R Leader2
  • Peter Sjoblom3
  • John A Eden4
  • Barry G Wren5
  • Gillian Z Heller6

  • 1 School of Women's and Children's Health, University of New South Wales, Sydney, NSW.
  • 2 Barbara Gross Research Unit, Sydney Menopause Centre, Royal Hospital for Women, Sydney, NSW.
  • 3 Department of Statistics, Macquarie University, Sydney, NSW.



We thank Dr C Magarey (St George Hospital, Sydney, NSW), Dr P Crea (St Vincent's Hospital Clinic, Sydney, NSW) and Dr P Schwartz (St George Hospital, Sydney, NSW) for providing access to medical records for this study.

Competing interests:

None identified.

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