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Jasmin Asberger Department of Obstetrics and Gynecology, Medical Center – University of Freiburg, Freiburg, Germany
Faculty of Medicine, University of Freiburg, Freiburg, Germany

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Thalia Erbes Department of Obstetrics and Gynecology, Medical Center – University of Freiburg, Freiburg, Germany
Faculty of Medicine, University of Freiburg, Freiburg, Germany

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Markus Jaeger Department of Obstetrics and Gynecology, Medical Center – University of Freiburg, Freiburg, Germany
Faculty of Medicine, University of Freiburg, Freiburg, Germany

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Gerta Rücker Institute of Medical Biometry and Statistics, Medical Center – University of Freiburg, Freiburg, Germany

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Claudia Nöthling Department of Obstetrics and Gynecology, Medical Center – University of Freiburg, Freiburg, Germany
Faculty of Medicine, University of Freiburg, Freiburg, Germany

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Andrea Ritter Department of Obstetrics and Gynecology, Medical Center – University of Freiburg, Freiburg, Germany
Faculty of Medicine, University of Freiburg, Freiburg, Germany

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Kai Berner Department of Obstetrics and Gynecology, Medical Center – University of Freiburg, Freiburg, Germany
Faculty of Medicine, University of Freiburg, Freiburg, Germany

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Ingolf Juhasz-Böss Department of Obstetrics and Gynecology, Medical Center – University of Freiburg, Freiburg, Germany
Faculty of Medicine, University of Freiburg, Freiburg, Germany

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Marc Hirschfeld Department of Obstetrics and Gynecology, Medical Center – University of Freiburg, Freiburg, Germany
Faculty of Medicine, University of Freiburg, Freiburg, Germany
Institute of Veterinary Medicine, Georg-August-University Goettingen, Goettingen, Germany

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Introduction With an incidence of 28.2%, breast cancer represents the most common type of cancer in females in Europe ( 1 ). Oestrogen-dependent gene expression regulation is known to play an important role in the promotion and progression of

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Kirsty G Pringle School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia

Hunter Medical Research Institute, New Lambton, Newcastle, New South Wales, Australia

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Sarah J Delforce School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia

Hunter Medical Research Institute, New Lambton, Newcastle, New South Wales, Australia

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Yu Wang School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia

Hunter Medical Research Institute, New Lambton, Newcastle, New South Wales, Australia

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Katie A Ashton School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia

Hunter Medical Research Institute, New Lambton, Newcastle, New South Wales, Australia

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Anthony Proietto Hunter Centre for Gynaecological Cancer, John Hunter Hospital, Newcastle, New South Wales, Australia

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Geoffrey Otton Hunter Centre for Gynaecological Cancer, John Hunter Hospital, Newcastle, New South Wales, Australia

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C Caroline Blackwell School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia

Hunter Medical Research Institute, New Lambton, Newcastle, New South Wales, Australia

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Rodney J Scott School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia

Hunter Medical Research Institute, New Lambton, Newcastle, New South Wales, Australia
Division of Molecular Medicine, Pathology North, Newcastle, New South Wales, Australia

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Eugenie R Lumbers School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia

Hunter Medical Research Institute, New Lambton, Newcastle, New South Wales, Australia

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HRT. Postmenopausal therapy with oestrogens alone predisposes to EC (IARC), which is sustained for up to 15 years after use ( 31 ). We do not know the nature or duration of HRT use in our cohort of women with EC. The use of oestrogen

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Sakina Kherra CHU Parnet Hopital, Algiers, Algeria

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Wendy Forsyth Paterson Royal Hospital for Sick Children, Yorkhill, Glasgow, UK

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Filiz Mine Cizmecioglu Paediatric Endocrinology and Diabetes Department, Kocaeli University, Kocaeli, Turkey

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Jeremy Huw Jones Department of Pediatric Endocrinology, Royal Hospital for Children Glasgow, NHS Greater Glasgow and Clyde, Glasgow, UK

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Mariam Kourime Abderrahim Harouchi Hôpital, Casablanca, Morocco

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Heba Hassan Elsedfy Pediatrics Department, Ain Shams University, Cairo, Egypt

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Sameh Tawfik Department of Pediatrics, Maadi Hospital, Cairo, Egypt

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Andreas Kyriakou Department of Pediatric Endocrinology, Royal Hospital for Children Glasgow, NHS Greater Glasgow and Clyde, Glasgow, UK

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Mohamad Guftar Shaikh Department of Pediatric Endocrinology, Royal Hospital for Children Glasgow, NHS Greater Glasgow and Clyde, Glasgow, UK

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Malcolm David Cairns Donaldson Section of Child Health, Glasgow University School of Medicine, Glasgow, UK

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cryptorchidism and sex hormone replacement therapy. Patients and methods At the inception of the Glasgow PWS clinic in 1991, the focus was initially on diagnosis, separating PWS patients from those with other causes of learning disability and obesity by

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Jennifer K Y Ko Department of Women’s Health, University College London Hospital, London, UK

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Thomas F J King Department of Women’s Health, University College London Hospital, London, UK

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Louise Williams Department of Women’s Health, University College London Hospital, London, UK

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Sarah M Creighton Department of Women’s Health, University College London Hospital, London, UK

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Gerard S Conway Department of Women’s Health, University College London Hospital, London, UK

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is a benefit to bone density ( 7 , 8 ). Local vaginal oestrogen was used by 9% of women, often prescribed as adjuvant therapy for those who require vaginal dilatation. Oestrogen implants were previously a popular choice but only a few users remained

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Anne M Drewes University of Aarhus, Aarhus C, Denmark

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Maria E Møller The Danish Cancer Society, Denmark (Kræftens Bekæmpelse), København Ø, Denmark

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Rasmus Hertzum-Larsen The Danish Cancer Society, Denmark (Kræftens Bekæmpelse), København Ø, Denmark

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Gerda Engholm The Danish Cancer Society, Denmark (Kræftens Bekæmpelse), København Ø, Denmark

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Hans H Storm The Danish Cancer Society, Denmark (Kræftens Bekæmpelse), København Ø, Denmark

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factors, hormonal levels, genetic factors and lifestyle ( 6 , 7 , 8 ). A well-known risk factor is the use of hormone replacement therapy, especially the oestrogen-progestagen combination, which increases risk compared to non-users ( 9 , 10 ). Tumours

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Xi Wang Department of Obstetrics and Gynaecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China

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Qi Yu Department of Obstetrics and Gynaecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China

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events, no increase in uterine volumes and no additional cases of torsion during the treatment or follow-up period. Other therapies have also been previously described. Fulvestrant, which binds to and rapidly degrades the oestrogen receptor, was found to

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Julia H Goedecke Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
Division of Exercise Science and Sport Medicine, Department of Human Biology, University of Cape Town, 3 Floor Sports Science Institute of South Africa Cape Town, South Africa

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Mehreen Tootla Division of Exercise Science and Sport Medicine, Department of Human Biology, University of Cape Town, 3 Floor Sports Science Institute of South Africa Cape Town, South Africa

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Dheshnie Keswell Division of Exercise Science and Sport Medicine, Department of Human Biology, University of Cape Town, 3 Floor Sports Science Institute of South Africa Cape Town, South Africa

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), whereas circulating oestrogen deficiency, experienced during the menopausal transition, is associated with an increase in central fat mass (FM), which is reduced with hormone replacement therapy ( 2 , 3 ). Central or upper-body fat accumulation, which

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Lachlan Angus Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia

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Shalem Leemaqz Robinson Research Institute, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia

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Olivia Ooi Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia

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Pauline Cundill Equinox Gender Diverse Clinic, Thorne Harbour Health, Fitzroy, Victoria, Australia

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Nicholas Silberstein Equinox Gender Diverse Clinic, Thorne Harbour Health, Fitzroy, Victoria, Australia

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Peter Locke Equinox Gender Diverse Clinic, Thorne Harbour Health, Fitzroy, Victoria, Australia

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Jeffrey D Zajac Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia

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Ada S Cheung Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Victoria, Australia

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.0008 ) 27595141 6 Tangpricha V den Heijer M . Oestrogen and anti-androgen therapy for transgender women . Lancet: Diabetes and Endocrinology 2017 5 . ( https://doi.org/10.1016/S2213-8587(16)30319-9 ) 7 Bretherton I Thrower E Grossmann M Zajac

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Felix Haglund Department of Oncology–Pathology, Cancer Centre Karolinska, Department of Biosciences and Nutrition, Department of Molecular Medicine and Surgery, Department of Surgery #4, Karolinska Institutet, Stockholm, Sweden
Department of Oncology–Pathology, Cancer Centre Karolinska, Department of Biosciences and Nutrition, Department of Molecular Medicine and Surgery, Department of Surgery #4, Karolinska Institutet, Stockholm, Sweden

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Gustaf Rosin Department of Oncology–Pathology, Cancer Centre Karolinska, Department of Biosciences and Nutrition, Department of Molecular Medicine and Surgery, Department of Surgery #4, Karolinska Institutet, Stockholm, Sweden
Department of Oncology–Pathology, Cancer Centre Karolinska, Department of Biosciences and Nutrition, Department of Molecular Medicine and Surgery, Department of Surgery #4, Karolinska Institutet, Stockholm, Sweden
Department of Oncology–Pathology, Cancer Centre Karolinska, Department of Biosciences and Nutrition, Department of Molecular Medicine and Surgery, Department of Surgery #4, Karolinska Institutet, Stockholm, Sweden

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Inga-Lena Nilsson Department of Oncology–Pathology, Cancer Centre Karolinska, Department of Biosciences and Nutrition, Department of Molecular Medicine and Surgery, Department of Surgery #4, Karolinska Institutet, Stockholm, Sweden

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C Christofer Juhlin Department of Oncology–Pathology, Cancer Centre Karolinska, Department of Biosciences and Nutrition, Department of Molecular Medicine and Surgery, Department of Surgery #4, Karolinska Institutet, Stockholm, Sweden
Department of Oncology–Pathology, Cancer Centre Karolinska, Department of Biosciences and Nutrition, Department of Molecular Medicine and Surgery, Department of Surgery #4, Karolinska Institutet, Stockholm, Sweden

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Ylva Pernow Department of Oncology–Pathology, Cancer Centre Karolinska, Department of Biosciences and Nutrition, Department of Molecular Medicine and Surgery, Department of Surgery #4, Karolinska Institutet, Stockholm, Sweden

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Sophie Norenstedt Department of Oncology–Pathology, Cancer Centre Karolinska, Department of Biosciences and Nutrition, Department of Molecular Medicine and Surgery, Department of Surgery #4, Karolinska Institutet, Stockholm, Sweden

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Andrii Dinets Department of Oncology–Pathology, Cancer Centre Karolinska, Department of Biosciences and Nutrition, Department of Molecular Medicine and Surgery, Department of Surgery #4, Karolinska Institutet, Stockholm, Sweden
Department of Oncology–Pathology, Cancer Centre Karolinska, Department of Biosciences and Nutrition, Department of Molecular Medicine and Surgery, Department of Surgery #4, Karolinska Institutet, Stockholm, Sweden
Department of Oncology–Pathology, Cancer Centre Karolinska, Department of Biosciences and Nutrition, Department of Molecular Medicine and Surgery, Department of Surgery #4, Karolinska Institutet, Stockholm, Sweden

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Catharina Larsson Department of Oncology–Pathology, Cancer Centre Karolinska, Department of Biosciences and Nutrition, Department of Molecular Medicine and Surgery, Department of Surgery #4, Karolinska Institutet, Stockholm, Sweden
Department of Oncology–Pathology, Cancer Centre Karolinska, Department of Biosciences and Nutrition, Department of Molecular Medicine and Surgery, Department of Surgery #4, Karolinska Institutet, Stockholm, Sweden

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Johan Hartman Department of Oncology–Pathology, Cancer Centre Karolinska, Department of Biosciences and Nutrition, Department of Molecular Medicine and Surgery, Department of Surgery #4, Karolinska Institutet, Stockholm, Sweden
Department of Oncology–Pathology, Cancer Centre Karolinska, Department of Biosciences and Nutrition, Department of Molecular Medicine and Surgery, Department of Surgery #4, Karolinska Institutet, Stockholm, Sweden

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Anders Höög Department of Oncology–Pathology, Cancer Centre Karolinska, Department of Biosciences and Nutrition, Department of Molecular Medicine and Surgery, Department of Surgery #4, Karolinska Institutet, Stockholm, Sweden
Department of Oncology–Pathology, Cancer Centre Karolinska, Department of Biosciences and Nutrition, Department of Molecular Medicine and Surgery, Department of Surgery #4, Karolinska Institutet, Stockholm, Sweden

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female patients. Without a reliable medical history, however, one cannot rule out a causal linkage to oestrogen levels or hormone replacement therapy. Results from epidemiological studies were indicative of an inverse association between PHPT incidence

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Martin Zweifel Department of Medical Oncology, University Hospital Bern, Bern, Switzerland

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Beat Thürlimann Breast Centre St. Gallen, Kantonsspital St. Gallen, St. Gallen, Switzerland

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Salome Riniker Breast Centre St. Gallen, Kantonsspital St. Gallen, St. Gallen, Switzerland

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Patrik Weder Breast Centre St. Gallen, Kantonsspital St. Gallen, St. Gallen, Switzerland

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Roger von Moos Kantonsspital Graubünden, Chur, Switzerland

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Olivia Pagani Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland

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Martin Bigler SAKK Coordinating Centre, Bern, Switzerland

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Karin M Rothgiesser SAKK Coordinating Centre, Bern, Switzerland

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Christiane Pilop SAKK Coordinating Centre, Bern, Switzerland

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Hanne Hawle SAKK Coordinating Centre, Bern, Switzerland

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Peter Brauchli SAKK Coordinating Centre, Bern, Switzerland

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Coya Tapia Institute of Pathology, University of Bern, Bern, Switzerland

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Wolfgang Schoenfeld CURADIS GmbH, Erlangen, Germany

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Cristiana Sessa Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland

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for the Swiss Group for Clinical Cancer Research (SAKK)
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therapy and not suitable for local treatment. Inclusion criteria were immunohistochemical oestrogen receptor (ER) positivity (≥1%) and/or progesterone receptor (PR) positivity (≥1%); in all cases, the tumour had to be human epidermal growth factor receptor

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