Recent breast cancer incidence trends according to hormone therapy use: the California Teachers Study cohort

Abstract

Introduction: Recent, international declines in breast cancer incidence are unprecedented, and the causes remain controversial. Few data sources can address breast cancer incidence trends according to pertinent characteristics like hormone therapy use history.

Methods: We used the prospective California Teachers Study to evaluate changes in self-reported use of menopausal hormone therapy (HT) between 1995 to 1996 and 2005 to 2006 and age-adjusted breast cancer incidence among 74,647 participants aged 50 years or older. Breast cancer occurrence was determined by linkage with the California Cancer Registry.

Results: During 517,286 woman years of follow up, 565 in situ and 2,668 invasive breast cancers were diagnosed. In situ breast cancer incidence rates in this population did not change significantly from 2000 to 2002 to 2003 to 2005, whereas rates of invasive breast cancer declined significantly by 26.0% from 528.0 (95% confidence intervals (CI) = 491.1, 564.9) per 100,000 women in 2000 to 2002 to 390.6 (95% CI = 355.6, 425.7) in 2003 to 2005. The decline in invasive breast cancer incidence rates was restricted to estrogen receptor-positive tumors. In 1996 to 1999 and 2000 to 2002 invasive breast cancer incidence was higher for women who reported current HT use especially estrogen-progestin (EP) use at baseline than for never or past users; but by 2003 to 2005 rates were comparable between these groups. For women who were taking EP in 2001 to 2002,75% of whom had stopped use by 2005 to 2006, incidence had declined 30.6% by 2003 to 2005 (P = 0.001); whereas incidence did not change significantly for those who never took HT (P = 0.33).

Conclusions: Few data resources can examine prospectively individual HT use and breast cancer diagnosis. Stable in situ breast cancer rates imply consistent levels of screening and suggest recent declines in invasive breast cancer to be explained predominantly by changes in HT use.

Figure 1

Age-adjusted incidence rates of breast cancer according to type of tumor and estrogen receptor (ER) status of invasive cancers among menopausal women 50 years or older in the California Teachers Study.

Figure 2

Age-adjusted incidence rates of invasive (solid lines) and in situ (dashed lines) breast cancer according to hormone therapy use at baseline in 1995-1996 among menopausal women 50 years or older in the California Teachers Study. E = estrogen only hormone therapy; EP = estrogen-progestin hormone therapy; HT = Hormone therapy.

Figure 3

Age-adjusted incidence rates of invasive (solid lines) and in situ (dashed lines) breast cancer according to hormone therapy use at follow-up in 2000-2001 among menopausal women 50 years or older in the California Teachers Study. E = estrogen only hormone therapy; EP = estrogen-progestin hormone therapy; HT = Hormone therapy.