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Menopausal hormone therapy and breast cancer risk: effect modification by body mass through life

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Abstract

It is not known whether increased breast cancer risk caused by menopausal hormone therapy (HT) depends on body mass patterns through life. In a prospective study of 483,241 Norwegian women aged 50–69 years at baseline, 7656 women developed breast cancer during follow-up (2006–2013). We combined baseline information on recalled body mass in childhood/adolescence and current (baseline) body mass index (BMI) to construct mutually exclusive life-course body mass patterns. We assessed associations of current HT use with breast cancer risk according to baseline BMI and life-course patterns of body mass, and estimated relative excess risk due to interaction (RERI). Within all levels of baseline BMI, HT use was associated with increased risk. Considering life-course body mass patterns as a single exposure, we used women who “remained at normal weight” through life as the reference, and found that being “overweight as young” was associated with lower risk (hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.76–0.94), whereas women who “gained weight” had higher risk (HR 1.20, 95% CI 1.12–1.28). Compared to never users of HT who were “overweight as young”, HT users who either “remained at normal weight” or “gained weight” in adulthood were at higher risk than expected when adding the separate risks (RERI 0.52, 95% CI 0.09–0.95, and RERI 0.37, 95% CI − 0.07–0.80), suggesting effect modification. Thus, we found that women who remain at normal weight or gain weight in adulthood may be more susceptible to the risk increasing effect of HT compared to women who were overweight as young.

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Acknowledgements

We are indebted to the women who participated in the Norwegian Breast Cancer Screening Program (NBCSP) and provided the information that is used in this study.

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Authors and Affiliations

  1. Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postboks 8905, 7491, Trondheim, Norway

    Marie Søfteland Sandvei, Lars J. Vatten & Signe Opdahl

  2. Department of Cancer and Palliative Care, Nordland Hospital Bodø, Bodø, Norway

    Marie Søfteland Sandvei

  3. Department of Clinical Medicine, University of Tromsø, Tromsø, Norway

    Marie Søfteland Sandvei

  4. Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway

    Elisabeth Krefting Bjelland & Anne Eskild

  5. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden

    Elisabeth Krefting Bjelland

  6. University of Oslo, Institute of Clinical Medicine, Campus Ahus, Oslo, Norway

    Anne Eskild

  7. Cancer Registry of Norway, Institute of Population-Based Research, Oslo, Norway

    Solveig Hofvind & Giske Ursin

  8. University of Oslo, Institute of Basic Medical Sciences, Oslo, Norway

    Giske Ursin

  9. Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA

    Giske Ursin

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Disclaimer The study has used data from the Cancer Registry of Norway. The interpretation and reporting of these data are the sole responsibility of the authors, and no endorsement by the Cancer Registry of Norway is intended nor should be inferred.

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Sandvei, M.S., Vatten, L.J., Bjelland, E.K. et al. Menopausal hormone therapy and breast cancer risk: effect modification by body mass through life. Eur J Epidemiol 34, 267–278 (2019). https://doi.org/10.1007/s10654-018-0431-7

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