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Menopausal hormone therapy and cancer risk: An overestimated risk?

  • Johanna Simin
    Affiliations
    Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research (CTMR), Karolinska Institutet, Nobels Väg 16, SE-171 77 Stockholm, Sweden

    Science for Life Laboratory (SciLifeLab), SE-171 21 Stockholm, Sweden
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  • Rulla Tamimi
    Affiliations
    Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
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  • Jesper Lagergren
    Affiliations
    Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

    Division of Cancer Studies, King's College London and Guy's and St Thomas' NHS Foundation Trust, United Kingdom
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  • Hans-Olov Adami
    Affiliations
    Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
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  • Nele Brusselaers
    Correspondence
    Corresponding author: Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research, Nobels Väg 16, SE-171 77 Stockholm, Sweden.
    Affiliations
    Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research (CTMR), Karolinska Institutet, Nobels Väg 16, SE-171 77 Stockholm, Sweden

    Science for Life Laboratory (SciLifeLab), SE-171 21 Stockholm, Sweden
    Search for articles by this author
Published:August 04, 2017DOI:https://doi.org/10.1016/j.ejca.2017.07.012

      Highlights

      • Menopausal hormone therapy (MHT) is the single most effective treatment for menopause-related symptoms.
      • Its use declined after 2002 because of a reported elevated breast cancer risk. Little is known on the overall cancer risk or other cancer types.
      • This contemporary MHT study showed a 9% increased cancer risk, with a decreased risk of all gastrointestinal cancer.
      • The cancer risk was more limited than expected, with variations for MHT types, formulations and regimens.

      Abstract

      Aim

      We aimed to assess the overall cancer risk among contemporary menopausal hormone therapy (MHT) users in Sweden and the risk for different cancer types.

      Methods

      A nationwide Swedish population-based cohort study including all 290,186 women aged ≥ 40 years having used systemic MHT during the study period (July 2005 and December 2012), compared with the Swedish female background population. MHT ever-use (all MHT, oestrogen-only MHT [E-MHT] and oestrogen plus progestin MHT [EP-MHT]) was based on the nationwide Prescribed Drug Registry. Cancer diagnoses were grouped into 16 different anatomical locations, for which standardised incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated.

      Results

      The SIR of any cancer was 1.09 (95% CI: 1.07–1.11) following ever MHT, 1.04 (95% CI: 1.01–1.06) for E-MHT and 1.14 (95% CI: 1.12–1.17) for EP-MHT. The highest SIR was found for EP-MHT among users aged ≥70 years (SIR = 1.33, 95% CI: 1.26–1.40). The risk for invasive breast, endometrial or ovarian cancer combined was increased for any MHT (SIR = 1.31, 95% CI: 1.28–1.34). The risk of invasive breast cancer was increased following MHT and increased with age for EP-MHT users. The risk of gastrointestinal cancers combined was decreased (SIR = 0.90, 95% CI: 0.86–0.94), particularly the oesophagus (SIR = 0.81, 95% CI: 0.64–1.00), liver (SIR = 0.81, 95% CI: 0.65–0.99) and colon (SIR = 0.90, 95% CI: 0.84–0.95).

      Conclusions

      MHT, notably EP-MHT, was associated with a limited increase in overall cancer risk. The increased risk of female reproductive organ cancers was almost balanced by a decreased risk of gastrointestinal cancers.

      Keywords

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