Abstract
The striking decline in United States breast cancer incidence since 2002 has been widely attributed to a reduction in postmenopausal hormone use, yet very little analysis has been conducted to quantify the contribution of changes in hormone use to the declining trend. We used literature-based estimates of the relative risk and the changing prevalence of hormone use to estimate the impact of hormone use on the decline in breast cancer incidence between 2002 and 2003 among women aged 40–79. For the base case of a 44% decline in hormone use and a relative risk for current use of 1.5, we estimated that 43% of the decline in incidence was attributable to hormone use. By exploring a range of parameter values, we found that high, unlikely values of the relative risk (i.e., ≥ 2.25) and/or the percent decline in hormone use (i.e., ≥ 75%) would be required to account for 100% of the observed decline in breast cancer incidence. We conclude that hormone use is unlikely to account for more than half of the observed decline in breast cancer incidence between 2002 and 2003. Further efforts are needed to quantify the potential contributions of other factors, such as the plateau in screening mammography utilization.
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Abbreviations
- WHI:
-
Women’s health initiative
- RR:
-
Relative risk
- SEER:
-
Surveillance Epidemiology and End Results
- ER:
-
Estrogen receptor
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Acknowledgments
We are grateful to Dr. Polly Newcomb for her advice and support and Dr. Diana Buist for providing access to her published data. This work was supported by the National Institutes of Health (CA067264). Dr. Sprague is supported by a Cancer Prevention Research Fellowship from the Prevent Cancer Foundation and the American Society of Preventive Oncology.
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Appendix
Appendix
To incorporate elevated risk (compared to never users) among women who quit using hormones after the WHI results, a few simple modifications to the model were made.
For the post-WHI period, Eq. (2) in the main model was replaced by the following relations:
where N c , N f , and N n are the number of current, former and never users, respectively. Breast cancer incidence among these groups are related to each other by the relative risk (RR):
Equation (5) in the main model was then replaced with the following equation for incidence in 2003:
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Sprague, B.L., Trentham-Dietz, A. & Remington, P.L. The contribution of postmenopausal hormone use cessation to the declining incidence of breast cancer. Cancer Causes Control 22, 125–134 (2011). https://doi.org/10.1007/s10552-010-9682-7
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DOI: https://doi.org/10.1007/s10552-010-9682-7