Postmenopausal Hormone Use, Screening, and Breast Cancer: Characterization and Control of a Bias

Joffe, Marshall M., Byrne, Celia and Colditz, Graham A. (2001) Postmenopausal Hormone Use, Screening, and Breast Cancer: Characterization and Control of a Bias. Epidemiology, 12 4: 429-438.


Author Joffe, Marshall M.
Byrne, Celia
Colditz, Graham A.
Title Postmenopausal Hormone Use, Screening, and Breast Cancer: Characterization and Control of a Bias
Journal name Epidemiology   Check publisher's open access policy
ISSN 1044-3983
Publication date 2001-07-01
Sub-type Article (original research)
Volume 12
Issue 4
Start page 429
End page 438
Total pages 10
Place of publication Baltimore, MD
Publisher Lippincott Williams & Wilkins
Collection year 2001
Language eng
Subject C1
321201 Environmental and Occupational Health and Safety
730213 Preventive medicine
Abstract Previous investigators have suggested that screening-related biases may explain associations between postmenopausal hormone use and breast cancer. To investigate these biases, we studied postmenopausal women in the Nurses' Health Study from 1988 to 1994. Hormone use is associated with increased subsequent screening. Among women not screened in the previous 2 years, the probability difference, comparing current hormone users with others, for having mammography in the following 2 years is 19.5%; among women previously screened, the difference is 4.9%. These differences persist after control for other factors. If the increase in screening is causal, screening by mammogram could be intermediate in the causal pathway to breast cancer diagnosis. To deal with this problem, we restrict attention to a subset of the cohort in which the effect of postmenopausal hormone use on screening is small (women previously screened). In this subset, the rate ratio comparing breast cancer rates among current postmenopausal hormone users with others is 1.28. In a sensitivity analysis, the bias could not by itself plausibly account for the associations in our data. Our data provide evidence of an association between postmenopausal hormone use and breast cancer that is not solely the product of a detection bias.
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Public Health Publications
 
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Created: Wed, 15 Aug 2007, 01:37:43 EST