Postmenopausal Hormone Replacement Therapy: Effect on Diagnosis and Outcome in Early-Stage Invasive Breast Cancer Treated With Conservative Surgery and Radiation

Abstract

PURPOSE: To compare the pretreatment characteristics and outcome of postmenopausal women with stage I-II breast cancer treated with conservative surgery and radiation who had a history of hormone replacement therapy (HRT) with those who had never received HRT. MATERIALS AND METHODS: From 1979 to 1993, 485 postmenopausal women underwent excisional biopsy, axillary dissection, and radiation for stage I-II breast cancer. The median follow-up was 5.9 years. One hundred forty-one patients reported a history of HRT. The median length of use was 5 years. Three hundred forty-four patients reported no history of HRT. RESULTS: Statistically significant differences between the two groups were observed for median age (HRT 60 years v no HRT 64 years; P =.0009), median weight (HRT 142 lbs v no HRT 152 lbs; P =.004), clinical tumor size < or = 2 cm (HRT 77% v no HRT 66%; P =.02), and the use of re-excision (HRT 62% v no HRT 49%; P =.01). The method of detection by mammogram only (HRT 52% v no HRT 42%; P =.06) was of borderline statistical significance. The HRT patients had a statistically significant increased cumulative incidence of ipsilateral breast tumor recurrence (8% v 2%; P =.02), a statistically significant decreased cumulative incidence of distant metastases (HRT 6% v no HRT 17%; P =.01), and a borderline statistically significant improvement in cause-specific survival at 10 years (HRT 92% v no HRT 86%; P =.07). Postmenopausal women with a history of HRT did not have an increased risk of contralateral breast cancer or second non-breast cancer malignancy. CONCLUSION: This study failed to identify an adverse effect of HRT on breast cancer mortality in patients with stage I-II disease treated with conservative surgery and radiation.