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Endometrial cancer risk in estrogen users after switching to estrogen–progestin therapy

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Abstract

Objective

It is unknown whether postmenopausal unopposed estrogen users are better off, in terms of endometrial cancer risk, switching to a combined estrogen–progestin regimen or stopping hormone use altogether.

Methods

We analyzed data from a series of three population-based case–control studies in western Washington state during 1985–1999, comparing proportions of “switchers” and “stoppers” in cases and controls. We also assessed whether the risk of endometrial cancer in either group of former unopposed estrogen users returned to that of never users.

Results

After multivariate adjustment using unconditional logistic regression, women who switched to a combined regimen with a progestin added for at least ten days/month (37 cases, 47 controls) had half the risk of endometrial cancer of women who stopped hormone use altogether (86 cases, 78 controls) (adjusted odds ratio = 0.5, 95% confidence interval: 0.3–1.1). Most subgroups of former users, whether they switched or stopped, had some increased risk of endometrial cancer compared to never users.

Conclusions

Results from this study suggest that unopposed estrogen users may reduce their risk of endometrial cancer more by switching to a combined regimen with progestin added for at least ten days/month than by stopping hormone use altogether.

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References

  1. Cook LS, Weiss NS (2000) Endometrial cancer. In: Goldman MB, Hatch MC (eds) Women and health. Academic Press, San Diego, pp 916–931

    Google Scholar 

  2. Jick H, Watkins RN, Hunter JR et al (1979) Replacement estrogens and endometrial cancer. N Engl J Med 300(5):218–222

    Article  PubMed  CAS  Google Scholar 

  3. Lacey JV Jr, Brinton LA, Lubin JH, Sherman ME, Schatzkin A, Schairer C (2005) Endometrial carcinoma risks among menopausal estrogen plus progestin and unopposed estrogen users in a cohort of postmenopausal women. Cancer Epidemiol Biomarkers Prev 14(7):1724–1731

    Article  PubMed  CAS  Google Scholar 

  4. Newcomb PA, Trentham-Dietz A (2003) Patterns of postmenopausal progestin use with estrogen in relation to endometrial cancer (United States). Cancer Causes Control 14(2):195–201

    Article  PubMed  Google Scholar 

  5. Paganini-Hill A, Ross RK, Henderson BE (1989) Endometrial cancer and patterns of use of oestrogen replacement therapy: a cohort study. Br J Cancer 59(3):445–447

    PubMed  CAS  Google Scholar 

  6. Shapiro S, Kelly JP, Rosenberg L et al (1985) Risk of localized and widespread endometrial cancer in relation to recent and discontinued use of conjugated estrogens. N Engl J Med 313(16):969–972

    Article  PubMed  CAS  Google Scholar 

  7. Weiss NS, Szekely DR, English DR, Schweid AI (1979) Endometrial cancer in relation to patterns of menopausal estrogen use. Jama 242(3):261–264

    Article  PubMed  CAS  Google Scholar 

  8. Finkle WD, Greenland S, Miettinen OS, Ziel HK (1995) Endometrial cancer risk after discontinuing use of unopposed conjugated estrogens (California, United States). Cancer Causes Control 6(2):99–102

    Article  PubMed  CAS  Google Scholar 

  9. Hulka BS, Fowler WC Jr, Kaufman DG et al (1980) Estrogen and endometrial cancer: cases and two control groups from North Carolina. Am J Obstet Gynecol 137(1):92–101

    PubMed  CAS  Google Scholar 

  10. Pettersson B, Adami HO, Persson I, Bergstrom R, Lindgren A, Johansson ED (1986) Climacteric symptoms and estrogen replacement therapy in women with endometrial carcinoma. Acta Obstet Gynecol Scand 65(1):81–87

    Article  PubMed  CAS  Google Scholar 

  11. Jain MG, Rohan TE, Howe GR (2000) Hormone replacement therapy and endometrial cancer in Ontario, Canada. J Clin Epidemiol 53(4):385–391

    Article  PubMed  CAS  Google Scholar 

  12. Rubin GL, Peterson HB, Lee NC, Maes EF, Wingo PA, Becker S (1990) Estrogen replacement therapy and the risk of endometrial cancer: remaining controversies. Am J Obstet Gynecol 162(1):148–154

    PubMed  CAS  Google Scholar 

  13. Pike MC, Peters RK, Cozen W et al (1997) Estrogen-progestin replacement therapy and endometrial cancer. J Natl Cancer Inst 89(15):1110–1116

    Article  PubMed  CAS  Google Scholar 

  14. Weiderpass E, Adami HO, Baron JA et al (1999) Risk of endometrial cancer following estrogen replacement with and without progestins. J Natl Cancer Inst 91(13):1131–1137

    Article  PubMed  CAS  Google Scholar 

  15. Beresford SA, Weiss NS, Voigt LF, McKnight B (1997) Risk of endometrial cancer in relation to use of oestrogen combined with cyclic progestagen therapy in postmenopausal women. Lancet 349(9050):458–461

    Article  PubMed  CAS  Google Scholar 

  16. Hill DA, Weiss NS, Beresford SA et al (2000) Continuous combined hormone replacement therapy and risk of endometrial cancer. Am J Obstet Gynecol 183(6):1456–1461

    Article  PubMed  CAS  Google Scholar 

  17. Doherty JA, Cushing-Haugen KL, Siebold B et al (2007) Long-term continuous combined use of postmenopausal hormone therapy and endometrial cancer risk. Am J Obstet Gynecol 197 (in press)

  18. Marchbanks PA, McDonald JA, Wilson HG et al (2002) The NICHD women’s contraceptive and reproductive experiences study: methods and operational results. Ann Epidemiol 12(4):213–221

    Article  PubMed  Google Scholar 

  19. Beresford SA, Coker AL (1989) Pictorially assisted recall of past hormone use in case-control studies. Am J Epidemiol 130(1):202–205

    PubMed  CAS  Google Scholar 

  20. McKnight B, Cook LS, Weiss NS (1999) Logistic regression analysis for more than one characteristic of exposure. Am J Epidemiol 149(11):984–992

    PubMed  CAS  Google Scholar 

  21. Ness RB, Buhari A, Gutai J, Kuller LH (2000) Reproductive history in relation to plasma hormone levels in healthy post-menopausal women. Maturitas 35:149–157

    Article  PubMed  CAS  Google Scholar 

  22. Figueroa-Casas PR, Ettinger B, Delgado E, Javkin A, Vieder C (2001) Reversal by medical treatment of endometrial hyperplasia caused by estrogen replacement therapy. Menopause 8(6):420–423

    Article  PubMed  CAS  Google Scholar 

  23. Ferenczy A, Gelfand M (1989) The biologic significance of cytologic atypia in progestogen-treated endometrial hyperplasia. Am J Obstet Gynecol 160(1):126–131

    PubMed  CAS  Google Scholar 

  24. Gambrell RD Jr (1997) Strategies to reduce the incidence of endometrial cancer in postmenopausal women. Am J Obstet Gynecol 177(5):1196–1204, discussion 204–207

    Article  PubMed  Google Scholar 

  25. Woodruff JD, Pickar JH (1994) Incidence of endometrial hyperplasia in postmenopausal women taking conjugated estrogens (Premarin) with medroxyprogesterone acetate or conjugated estrogens alone. The menopause study group. Am J Obstet Gynecol 170(5 Pt 1):1213–1223

    PubMed  CAS  Google Scholar 

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Acknowledgments

We are grateful to Dr. Kathleen Malone (Fred Hutchinson Cancer Research Center) for facilitating the use of the CARE data (N01 HD 2 3166) and to Dr. Susan Reed (University of Washington) for many helpful suggestions. We would like to thank the participants in our series of endometrial cancer studies, as well as the participants in the National Institute of Child Health and Development CARE study. The project was supported by grants CA 105212, R35 CA 39779, R01 CA 47749, R01 CA 75977, N01 HD 2 3166, and K05 CA 92002. Jessica Chubak was supported by grant number 5 T32 CA09168 from the National Cancer Institute (NCI). The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the NCI.

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Authors and Affiliations

  1. Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Jessica Chubak, Jennifer A. Doherty, Kara L. Cushing-Haugen, Lynda F. Voigt, Babette S. Saltzman, Shirley A. A. Beresford & Noel S. Weiss

  2. Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Box 357236, Seattle, WA, 98195-7236, USA

    Jessica Chubak, Lynda F. Voigt, Babette S. Saltzman, Shirley A. A. Beresford & Noel S. Weiss

  3. Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA

    Deirdre A. Hill

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  1. Jessica Chubak
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  2. Jennifer A. Doherty
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  3. Kara L. Cushing-Haugen
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  4. Lynda F. Voigt
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  5. Babette S. Saltzman
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  6. Deirdre A. Hill
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  7. Shirley A. A. Beresford
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  8. Noel S. Weiss
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Correspondence to Jessica Chubak.

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Chubak, J., Doherty, J.A., Cushing-Haugen, K.L. et al. Endometrial cancer risk in estrogen users after switching to estrogen–progestin therapy. Cancer Causes Control 18, 1001–1007 (2007). https://doi.org/10.1007/s10552-007-9040-6

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  • DOI: https://doi.org/10.1007/s10552-007-9040-6

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