Progesterone vs. synthetic progestins and the risk of breast cancer

A systematic review and meta-analysis

Noor Asi, Khaled Mohammed, Qusay Haydour, Michael R. Gionfriddo, Oscar L Morey Vargas, Larry J. Prokop, Stephanie S. Faubion, Mohammad H Murad

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background: Use of menopausal hormonal therapy (MHT)-containing estrogen and a synthetic progestin is associated with an increased risk of breast cancer. It is unclear if progesterone in combination with estrogen carries a lower risk of breast cancer. Limited data suggest differences between progesterone and progestins on cardiovascular risk factors, including cholesterol and glucose metabolism. Whether this translates to differences in cardiovascular outcomes is uncertain. We conducted a systematic review and meta-analysis to synthesize the existing evidence about the effect of progesterone in comparison to synthetic progestins, each in combination with estrogens, on the risk of breast cancer and cardiovascular events. Methods: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Scopus through 17 May 2016 for studies that enrolled postmenopausal women using progesterone vs. synthetic progestins and reported the outcomes of interest. Study selection and data extraction were performed by two independent reviewers. Meta-analysis was conducted using the random effects model. Results: We included two cohort studies and one population-based case-control study out of 3410 citations identified by the search. The included studies enrolled 86,881 postmenopausal women with mean age of 59 years and follow-up range from 3 to 20 years. The overall risk of bias of the included cohort studies in the meta-analysis was moderate. There was no data on cardiovascular events. Progesterone was associated with lower breast cancer risk compared to synthetic progestins when each is given in combination with estrogen, relative risk 0.67; 95 % confidence interval 0.55-0.81. Conclusions: Observational studies suggest that in menopausal women, estrogen and progesterone use may be associated with lower breast cancer risk compared to synthetic progestin.

Original languageEnglish (US)
Article number121
JournalSystematic Reviews
Volume5
Issue number1
DOIs
StatePublished - Jul 26 2016

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Progesterone Congeners
Progesterone
Meta-Analysis
Breast Neoplasms
Estrogens
Cohort Studies
Progestins
MEDLINE
Observational Studies
Case-Control Studies
Cholesterol
Confidence Intervals
Glucose

Keywords

  • Breast cancer
  • Cardiovascular events
  • Meta-analysis
  • Progesterone
  • Synthetic progestins
  • Systematic review

ASJC Scopus subject areas

  • Medicine (miscellaneous)

Cite this

Progesterone vs. synthetic progestins and the risk of breast cancer : A systematic review and meta-analysis. / Asi, Noor; Mohammed, Khaled; Haydour, Qusay; Gionfriddo, Michael R.; Vargas, Oscar L Morey; Prokop, Larry J.; Faubion, Stephanie S.; Murad, Mohammad H.

In: Systematic Reviews, Vol. 5, No. 1, 121, 26.07.2016.

Research output: Contribution to journalArticle

Asi, N, Mohammed, K, Haydour, Q, Gionfriddo, MR, Vargas, OLM, Prokop, LJ, Faubion, SS & Murad, MH 2016, 'Progesterone vs. synthetic progestins and the risk of breast cancer: A systematic review and meta-analysis', Systematic Reviews, vol. 5, no. 1, 121. https://doi.org/10.1186/s13643-016-0294-5
Asi, Noor ; Mohammed, Khaled ; Haydour, Qusay ; Gionfriddo, Michael R. ; Vargas, Oscar L Morey ; Prokop, Larry J. ; Faubion, Stephanie S. ; Murad, Mohammad H. / Progesterone vs. synthetic progestins and the risk of breast cancer : A systematic review and meta-analysis. In: Systematic Reviews. 2016 ; Vol. 5, No. 1.
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abstract = "Background: Use of menopausal hormonal therapy (MHT)-containing estrogen and a synthetic progestin is associated with an increased risk of breast cancer. It is unclear if progesterone in combination with estrogen carries a lower risk of breast cancer. Limited data suggest differences between progesterone and progestins on cardiovascular risk factors, including cholesterol and glucose metabolism. Whether this translates to differences in cardiovascular outcomes is uncertain. We conducted a systematic review and meta-analysis to synthesize the existing evidence about the effect of progesterone in comparison to synthetic progestins, each in combination with estrogens, on the risk of breast cancer and cardiovascular events. Methods: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Scopus through 17 May 2016 for studies that enrolled postmenopausal women using progesterone vs. synthetic progestins and reported the outcomes of interest. Study selection and data extraction were performed by two independent reviewers. Meta-analysis was conducted using the random effects model. Results: We included two cohort studies and one population-based case-control study out of 3410 citations identified by the search. The included studies enrolled 86,881 postmenopausal women with mean age of 59 years and follow-up range from 3 to 20 years. The overall risk of bias of the included cohort studies in the meta-analysis was moderate. There was no data on cardiovascular events. Progesterone was associated with lower breast cancer risk compared to synthetic progestins when each is given in combination with estrogen, relative risk 0.67; 95 {\%} confidence interval 0.55-0.81. Conclusions: Observational studies suggest that in menopausal women, estrogen and progesterone use may be associated with lower breast cancer risk compared to synthetic progestin.",
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AU - Gionfriddo, Michael R.

AU - Vargas, Oscar L Morey

AU - Prokop, Larry J.

AU - Faubion, Stephanie S.

AU - Murad, Mohammad H

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AB - Background: Use of menopausal hormonal therapy (MHT)-containing estrogen and a synthetic progestin is associated with an increased risk of breast cancer. It is unclear if progesterone in combination with estrogen carries a lower risk of breast cancer. Limited data suggest differences between progesterone and progestins on cardiovascular risk factors, including cholesterol and glucose metabolism. Whether this translates to differences in cardiovascular outcomes is uncertain. We conducted a systematic review and meta-analysis to synthesize the existing evidence about the effect of progesterone in comparison to synthetic progestins, each in combination with estrogens, on the risk of breast cancer and cardiovascular events. Methods: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Scopus through 17 May 2016 for studies that enrolled postmenopausal women using progesterone vs. synthetic progestins and reported the outcomes of interest. Study selection and data extraction were performed by two independent reviewers. Meta-analysis was conducted using the random effects model. Results: We included two cohort studies and one population-based case-control study out of 3410 citations identified by the search. The included studies enrolled 86,881 postmenopausal women with mean age of 59 years and follow-up range from 3 to 20 years. The overall risk of bias of the included cohort studies in the meta-analysis was moderate. There was no data on cardiovascular events. Progesterone was associated with lower breast cancer risk compared to synthetic progestins when each is given in combination with estrogen, relative risk 0.67; 95 % confidence interval 0.55-0.81. Conclusions: Observational studies suggest that in menopausal women, estrogen and progesterone use may be associated with lower breast cancer risk compared to synthetic progestin.

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