We examined the relationship between use of progestagen-only before menopause (except for mini-pills) after the age of 40 and invasive breast cancer risk in 73 664 women from the French E3N cohort study (mean age at start of follow-up, 51.8 years; mean duration of follow-up, 9.1 years). A total of 2390 cases of invasive breast cancer were diagnosed during follow-up. Risk estimates were calculated using the Cox proportional hazard model. Overall, ever use of progestagen before menopause was not significantly associated with risk (relative risk (RR): 1.01, 95% confidence interval: 0.93-1.11). However, we observed a significant increase in risk associated with the duration of use (P-value for trend: 0.012), current use of progestagens for longer than 4.5 years being significantly associated with risk (RR: 1.44, 95% confidence interval: 1.03-2.00). Prolonged use of progestagens after the age of 40 may be associated with an increased risk of breast cancer and the subject needs to be investigated further.

Fabre A, Fournier A, Mesrine S, Desreux J, Gompel A, Boutron-Ruault MC, Clavel-Chapelon F.

Institut National de la Santé et de la Recherche Médicale, ERI 20, Institut Gustave Roussy, 39, rue Camille Desmoulins, F-94805 Villejuif, Cedex, France.

Br J Cancer. 2007 Mar 12;96(5):841-4. Epub 2007 Feb 13.

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In recent years, research on menopausal symptomalogy has focused on identifying symptom groupings experienced by women as they progress from premenopausal to postmenopausal status. However, most of these studies have been conducted among Caucasian women from western cultures. This leaves open the question of whether the findings from these studies can be extended to women of other racial/ethnic groups or cultures. Furthermore, many of the previous studies have been conducted on relatively small samples. This paper addresses the diversity of the menopause experience by comparing symptom reporting in a large cross-sectional survey of women aged 40–55 years among racial/ethnic groups of women in the United States (Caucasian, African-American, Chinese, Japanese, and Hispanic). Evaluation of the extent to which symptoms group together and consistently relate to menopausal status across these five samples provides evidence for or against a universal menopausal syndrome. The specific research questions addressed in this paper are: (1) How does the factor structure of symptoms among mid-aged women compare across racial/ethnic groups? (2) Is symptom reporting related to race/ethnicity or menopausal status? and (3) Does the relation between menopausal status and symptoms vary across racial/ethnic groups?

Analyses are based on 14,906 women who participated in the multi-ethnic, multi-race, multi-site study of mid-aged women called the Study of Women’s Health Across the Nation (SWAN). Study participants completed a 15-min telephone or in-person interview that contained questions on a variety of health-related topics. Items of interest for these analyses include symptoms, menstrual history (to assess menopausal status), health status, and sociodemographics.

Factor analysis results showed that across all five racial/ethnic groups, two consistent factors emerged; one consisting of clearly menopausal symptoms — hot flashes and night sweats — and the other consisting of psychological and psychosomatic symptoms. Results of regression analyses showed racial/ethnic differences in symptom reporting, as well as differences by menopausal status. Controlling for age, education, health, and economic strain, Caucasian women reported significantly more psychosomatic symptoms than other racial/ethnic groups. African-American women reported significantly more vasomotor symptoms. Perimenopausal women, hormone users, and women who had a surgical menopause reported significantly more vasomotor symptoms. All of these groups, plus postmenopausal women, reported significantly more vasomotor symptoms than premenopausal women. The pattern of results argues against a universal menopausal syndrome consisting of a variety of vasomotor and psychological symptoms.

Nancy E. Avis^a, Rebecca Stellato^a, Sybil Crawford^a, Joyce Bromberger^b, Patricia Ganz^c, Virginia Cain^d and Marjorie Kagawa-Singer^e
a New England Research Institutes, 9 Galen Street, Watertown, MA 02472, USA
^b Departments of Epidemiology and Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
^c University of California at Los Angeles, School of Medicine, Los Angeles, CA, USA
^d Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MA, USA
^e University of California at Los Angeles, School of Public Health, Los Angeles, CA, USA

Corresponding author. Tel.: +1-617-923-7747 ext. 310; fax: +1-617-926-8246; email: nancya@neri.org

Social Science & Medicine
Volume 52, Issue 3, February 2001, Pages 345-356