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Randomized trials of estrogen-alone and breast cancer incidence: a meta-analysis

Breast cancer research and treatment, 2024-04 [Peer Reviewed Journal]

2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature. ;EISSN: 1573-7217 ;DOI: 10.1007/s10549-024-07307-9 ;PMID: 38653905

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  • Title:
    Randomized trials of estrogen-alone and breast cancer incidence: a meta-analysis
  • Author: Chlebowski, Rowan T ; Aragaki, Aaron K ; Pan, Kathy ; Mortimer, Joanne E ; Johnson, Karen C ; Wactawski-Wende, Jean ; LeBoff, Meryl S ; Lavasani, Sayeh ; Lane, Dorothy ; Nelson, Rebecca A ; Manson, JoAnn E
  • Is Part Of: Breast cancer research and treatment, 2024-04
  • Description: In the Women's Health initiative (WHI) randomized clinical trial, conjugated equine estrogen (CEE)-alone significantly reduced breast cancer incidence (P = 0.005). As cohort studies had opposite findings, other randomized clinical trials were identified to conduct a meta-analysis of estrogen-alone influence on breast cancer incidence. We conducted literature searches on randomized trials and: estrogen, hormone therapy, and breast cancer, and searches from a prior meta-analysis and reviews. In the meta-analysis, for trials with published relative risks (RR) and 95% confidence intervals (CI), each log-RR was multiplied by weight = 1/V, where V = variance of the log-RR, and V was derived from the corresponding 95% CI. For smaller trials with only breast cancer numbers, the corresponding log-RR = (O - E)/weight, where O is the observed case number in the oestrogen-alone group and E the corresponding expected case number, E = nP. Findings from 10 randomized trials included 14,282 participants and 591 incident breast cancers. In 9 smaller trials, with 1.2% (24 of 2029) vs 2.2% (33 of 1514) randomized to estrogen-alone vs placebo (open label, one trial) (RR 0.65 95% CI 0.38-1.11, P = 0.12). For 5 trials evaluating estradiol formulations, RR = 0.63 95% CI 0.34-1.16, P = 0.15. Combining the 10 trials, 3.6% (262 of 7339) vs 4.7% (329 of 6943) randomized to estrogen-alone vs placebo (overall RR 0.77 95% CI 0.65-0.91, P = 0.002). The totality of randomized clinical trial evidence supports a conclusion that estrogen-alone use significantly reduces breast cancer incidence.
  • Publisher: Netherlands
  • Language: English
  • Identifier: EISSN: 1573-7217
    DOI: 10.1007/s10549-024-07307-9
    PMID: 38653905
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