Abstract
Objectives
The aim of this work was to verify the existence of and characterise the relationship
between premenopausal progestogen use, subsequent use of estrogen–progestogen therapy
(EPT) and risk factors for breast cancer, and to describe and analyse premenopausal
progestogen use among women participating in a longitudinal study.
Methods
Data came from self-administered questionnaires mailed to 2254 pre- or peri-menopausal
women aged 45 years or older participating in the French GAZEL cohort and followed
for 10 years. Bivariate and multivariate analyses first examined the association between
progestogen use and women's and physicians’ characteristics. A generalised linear
model was then used to analyse the association between progestogen use and EPT use,
while taking into account factors associated with progestogen use.
Results
Thirty-six percent of the women had used progestogens before menopause: 56% of them
19-norpregnane derivatives, and 13% 17α hydroxyprogesterone derivatives. They were
more likely to report breast pain, a family history of breast cancer and mood changes,
to be thin, to consult a gynaecologist rather than a general practitioner, to consult
a female physician, and to consult often. Of the 1756 women who had reached menopause,
EPT users were more likely to have used progestogens premenopausally (adjusted RR:
1.2; 95% CI: 1.1–1.3).
Conclusions
Physician characteristics play an important role in the use of progestogens before
menopause. Our results also suggest that women using progestogens may have a higher
risk of breast cancer, that is, that progestogen use may be a confounding rather than
causal factor. The analyses concerning the relationship between EPT use and breast
cancer risk must take progestogen use before menopause into account, as they do other
confounding factors, such as age at menarche, parity, and use of oral contraceptives.
Keywords
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Article info
Publication history
Published online: September 14, 2007
Accepted:
August 8,
2007
Received in revised form:
July 31,
2007
Received:
May 10,
2007
Identification
Copyright
© 2007 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
