gms | German Medical Science

MAINZ//2011: 56. GMDS-Jahrestagung und 6. DGEpi-Jahrestagung

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e. V.
Deutsche Gesellschaft für Epidemiologie e. V.

26. - 29.09.2011 in Mainz

Impact of menopausal hormone therapy, breast tumor characteristics, and treatment on overall survival of 3813 breast cancer patients (The Marieplus study)

Meeting Abstract

  • Nadia Obi - UCCH, Universitätsklinikum Hamburg Eppendorf, Hamburg
  • Judit Heinz - UCCH, Universitätsklinikum Hamburg Eppendorf, Hamburg
  • Alina Vrieling - Deutsches Krebsforschungszentrum, Heidelberg
  • Jenny Chang-Claude - Deutsches Krebsforschungszentrum, Heidelberg
  • Dieter Flesch-Janys - UCCH, Universitätsklinikum Hamburg Eppendorf, Hamburg

Mainz//2011. 56. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 6. Jahrestagung der Deutschen Gesellschaft für Epidemiologie (DGEpi). Mainz, 26.-29.09.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11gmds217

doi: 10.3205/11gmds217, urn:nbn:de:0183-11gmds2176

Published: September 20, 2011

© 2011 Obi et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Introduction: Menopausal hormone therapy (HT) is a well established risk factor for developing breast cancer. However, the impact of pre-diagnostic HT use on overall mortality is controversial. The majority of observational studies found a reduced breast cancer mortality, while in the follow-up of the Women’s Health Initiative (WHI) trial [1] HT was associated with a doubling of hazard ratio (HR). To further elucidate the impact of HT on overall survival we analyzed follow-up information of the population based case cohort of the MARIE study.

Methods: Incident breast cancer cases (N = 3813) recruited in 2002-2005 were followed up to the end of 2009. Vital status and causes of death certificates were ascertained. Cox proportional hazard analysis was performed with self-reported pre-diagnostic HT as exposure adjusting for age, characteristics of the primary tumor, treatment, various lifestyle factors, mode of detection and number of mammograms prior to diagnosis.

Results: After a median follow-up of 6.2 years 507 deaths (13.3%) occurred, of which 70% were due to breast cancer. The prognostic tumor characteristics TNM-status, grading and hormone receptors showed significant associations with overall survival. Compared with never users of HT, current HT users of any type had a significantly lower mortality risk (adjusted HR 0.58, 95% CI 0.45-0.74), but not past HT users (HR 0.83, 95% CI 0.62-1.09). The most pronounced risk reduction was seen for continuously combined estrogen-progestin (HR 0.52, 0.37-0.73), the less for mono-estrogen preparations (HR 0.68, 0.46 -0.99).

Discussion: Our results are in line with several former studies [2], [3] which also found an inverse association of pre-diagnostic HT use and survival after breast cancer, though inconsistent with results reported by the WHI [1] and the Million Women Study [4]. Further analysis will be performed to evaluate more closely the HT user profiles (including HT duration, age at start of HT use) and potentially unobserved confounding (e.g. differential co-morbidity between HT non-users and users) by stratification for age and tumor subgroups.


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