Research table: Blood androgen levels and breast cancer risk

This summary table contains detailed information about research studies. Summary tables are a useful way to look at the science behind many breast cancer guidelines and recommendations. However, to get the most out of the tables, it’s important to understand some key concepts. Learn how to read a research table.

Introduction: Androgens (such as testosterone) are natural hormones. They are important in sexual development in both men and women.

In women, androgens are produced in small amounts by the ovaries and the adrenal glands. Higher levels of androgens in the blood may be linked to an increased risk of breast cancer in women.

Of the androgens, testosterone has been studied the most in relation to breast cancer risk.

Breast cancer risk after menopause

Studies show higher blood levels of testosterone may be linked to an increased risk of breast cancer in postmenopausal women.

Menopausal hormone therapy

Most of the studies below excluded women who were taking menopausal hormone therapy (MHT) at the time of the blood collection. MHT is FDA-approved for the short-term relief of menopausal symptoms. MHT is also called postmenopausal hormone therapy or hormone replacement therapy (HRT).

Women who use MHT have an increased risk of breast cancer. This increased breast cancer risk related to MHT may make it difficult to see a link between natural blood testosterone levels and breast cancer risk in study data. By looking only at women who don’t take (or who’ve never taken) MHT, researchers may see more clearly how blood androgen levels are related to breast cancer risk.

Learn more about MHT and breast cancer risk.

Breast cancer risk before menopause

A pooled analysis of data from 5 studies found women with higher levels of blood testosterone had an increased risk of premenopausal breast cancer [1].

Learn more about blood androgen levels and breast cancer risk.

Learn about the strengths and weaknesses of different types of studies.

See how this risk factor compares with other risk factors for breast cancer.

Study selection criteria: Prospective cohort studies, nested case-control studies, case-control studies and pooled analyses with at least 100 breast cancer cases.

Table notes: Odds ratios above 1 indicate increased risk. Odds ratios below 1 indicate decreased risk.

Relative risks related to total testosterone levels (unless noted) are shown in this table.  

Study	Study Population (number of participants)		Risk of Breast Cancer in Women with Higher Testosterone Levels Compared to Women with Lower Testosterone Levels, Odds Ratio (95% CI)
			Before Menopause	After Menopause
Prospective cohort studies
UK Biobank [2]	260,079 (8,858 cases)		1.33 (1.16-1.53)	1.52 (1.42-1.63)
Nested case-control studies
	Cases	Controls
Nurses’ Health Study [3]	770	1,414		1.5 (1.2-1.9)*
EPIC cohort [4-5]	677	1,309		1.85 (1.33–2.57)
	370	726	1.73 (1.16-2.57)
Melbourne Collaborative Cohort Study [6]	342	866		1.04 (0.72-1.50)†
Women’s Health Initiative Observational Study [7]	317	594		Estrogen receptor-positive cancers: 1.55 (0.92-2.61)‡  Estrogen receptor-negative cancers: 0.51 (0.28-0.94)‡
NYU Women’s Health Study [8-9]	297	563		2.05 (1.19-3.53)
	274	683	1.5 (1.1-2.2)
Nurses’ Health Study II [10]	278	858	1.01 (0.8-1.4)
	100	271		1.8 (1.1-2.8)
UK Collaborative Trial of Ovarian Cancer Screening [11]	200	400		2.15 (1.26-3.71)
Manjer et al. [12]	173	438		1.87 (1.08-3.25)
ORDET cohort [13-14]	165	672		3.28 (1.93-5.55)
	104	225	1.27 (0.52-2.51)§
Case-control studies
Wang et al. [15]	367	367	1.41 (0.61-3.26)||	2.83 (1.20-6.67)
Yu et al. [16]	300	300	2.01 (0.96-4.21)	2.40 (1.11-5.21)
Sturgeon et al. [17]	169	195	1.12 (0.6-2.5)
Pooled analyses
	Cases	Controls
EHBCCG [1,18]	767	1,699	1.32 (0.98-1.76)
	663	1,765		2.22 (1.59-3.10)

* Relative risk for hormone receptor-positive breast cancers was 1.8 (1.3-2.5). Relative risk for hormone receptor-negative breast cancers was 0.6 (0.3-1.2).

† All breast cancers were estrogen receptor-positive.

‡ Results are for blood levels of bioavailable testosterone.

§ Results are for testosterone blood levels measured in the luteal phase of the menstrual cycle.

|| Results are for testosterone blood levels measured in the luteal phase of the menstrual cycle. For testosterone blood levels measured in the early follicular stage, findings were similar, with a relative risk of 0.45 (0.17-1.19).

References

1. Endogenous Hormones and Breast Cancer Collaborative Group. Sex hormones and risk of breast cancer in premenopausal women: a collaborative reanalysis of individual participant data from seven prospective studies. Lancet Oncol. 14(10):1009-19, 2013.
2. Zhang Y, Huang X, Yu X, He W, Czene K, Yang H. Hematological and biochemical markers influencing breast cancer risk and mortality: prospective cohort study in the UK Biobank by multi-state models. Breast. 73:103603, 2024.
3. Zhang X, Tworoger SS, Eliassen AH, Hankinson SE. Postmenopausal plasma sex hormone levels and breast cancer risk over 20 years of follow-up. Breast Cancer Res Treat. 137(3):883-92, 2013.
4. Kaaks R, Rinaldi S, Key TJ, et al. Postmenopausal serum androgens, oestrogens and breast cancer risk: the European prospective investigation into cancer and nutrition. Endocr Relat Cancer. 12(4):1071-82, 2005.
5. Kaaks R, Berrino F, Key T, et al. Serum sex steroids in premenopausal women and breast cancer risk within the European Prospective Investigation into Cancer and Nutrition (EPIC). J Natl Cancer Inst. 97(10):755-65, 2005.
6. Albers FEM, Lou MWC, Dashti SG, et al. Sex-steroid hormones and risk of postmenopausal estrogen receptor-positive breast cancer: a case-cohort analysis. Cancer Causes Control. 2024 Feb 16 [Online ahead of print].
7. Farhat GN, Cummings SR, Chlebowski RT, et al. Sex hormone levels and risks of estrogen receptor-negative and estrogen receptor-positive breast cancers. J Natl Cancer Inst. 103(7):562-70, 2011.
8. Zeleniuch-Jacquotte A, Shore RE, Koenig KL, et al. Postmenopausal levels of oestrogen, androgen, and SHBG and breast cancer: long-term results of a prospective study. Br J Cancer. 90(1):153-9, 2004.
9. Zeleniuch-Jacquotte A, Afanasyeva Y, Kaaks R, et al. Premenopausal serum androgens and breast cancer risk: a nested case-control study. Breast Cancer Res. 14(1):R32, 2012.
10. Fortner RT, Eliassen AH, Spiegelman D, Willett WC, Barbieri RL, Hankinson SE. Premenopausal endogenous steroid hormones and breast cancer risk: results from the Nurses’ Health Study II. Breast Cancer Res. 15(2):R19, 2013.
11. Fourkala EO, Zaikin A, Burnell M, et al. Association of serum sex steroid receptor bioactivity and sex steroid hormones with breast cancer risk in postmenopausal women. Endocr Relat Cancer. 19(2):137-47, 2012.
12. Manjer J, Johansson R, Berglund G, et al. Postmenopausal breast cancer risk in relation to sex steroid hormones, prolactin and SHBG (Sweden). Cancer Causes Control. 14(7):599-607, 2003.
13. Sieri S, Krogh V, Bolelli G, et al. Sex hormone levels, breast cancer risk, and cancer receptor status in postmenopausal women: the ORDET cohort. Cancer Epidemiol Biomarkers Prev. 18(1):169-76, 2009.
14. Schernhammer ES, Sperati F, Razavi P, et al. Endogenous sex steroids in premenopausal women and risk of breast cancer: the ORDET cohort. Breast Cancer Res. 15(3):R46, 2013.
15. Wang B, Mi M, Wang J, et al. Does the increase of endogenous steroid hormone levels also affect breast cancer risk in Chinese women? A case-control study in Chongqing, China. Int J Cancer. 124(8):1892-9, 2009.
16. Yu H, Shu XO, Shi R, et al. Plasma sex steroid hormones and breast cancer risk in Chinese women. Int J Cancer. 105(1):92-7, 2003.
17. Sturgeon SR, Potischman N, Malone KE, et al. Serum levels of sex hormones and breast cancer risk in premenopausal women: a case-control study (USA). Cancer Causes Control. 15(1):45-53, 2004.
18. Key T, Appleby P, Barnes I, Reeves G for the Endogenous Hormones and Breast Cancer Collaborative Group. Endogenous sex hormones and breast cancer in postmenopausal women: reanalysis of nine prospective studies. J Natl Cancer Inst. 94(8):606-16, 2002.

Updated 06/05/24