Estrogen plus progestin and colorectal cancer in postmenopausal women
- PMID: 14999111
- DOI: 10.1056/NEJMoa032071
Estrogen plus progestin and colorectal cancer in postmenopausal women
Abstract
Background: Although the Women's Health Initiative (WHI) trial of estrogen plus progestin in postmenopausal women identified more overall health risks than benefits among women in the hormone group, the use of estrogen plus progestin was associated with a significant decrease in the risk of colorectal cancer. We analyzed features of the colorectal cancers that developed and their relation to the characteristics of the participants.
Methods: In the WHI trial, 16,608 postmenopausal women who were 50 to 79 years of age and had an intact uterus were randomly assigned to a combination of conjugated equine estrogens (0.625 mg per day) plus medroxyprogesterone acetate (2.5 mg per day) or placebo. The main outcome measures were the incidence, stages, and types of colorectal cancer, as determined by blinded central adjudication.
Results: There were 43 invasive colorectal cancers in the hormone group and 72 in the placebo group (hazard ratio, 0.56; 95 percent confidence interval, 0.38 to 0.81; P=0.003). The invasive colorectal cancers in the hormone group were similar in histologic features and grade to those in the placebo group but with a greater number of positive lymph nodes (mean +/-SD, 3.2+/-4.1 vs. 0.8+/-1.7; P=0.002) and were more advanced (regional or metastatic disease, 76.2 percent vs. 48.5 percent; P=0.004). In exploratory analyses, women in the hormone group with antecedent vaginal bleeding had colorectal cancers with a greater number of positive nodes than women in the hormone group who did not have vaginal bleeding (3.8+/-4.3 vs. 0.7+/-1.5 nodes, P=0.006).
Conclusions: Relatively short-term use of estrogen plus progestin was associated with a decreased risk of colorectal cancer. However, colorectal cancers in women who took estrogen plus progestin were diagnosed at a more advanced stage than those in women who took placebo.
Copyright 2004 Massachusetts Medical Society
Comment in
-
Estrogen plus progestin and colorectal cancer in postmenopausal women.N Engl J Med. 2004 Jun 3;350(23):2417-9; author reply 2417-9. doi: 10.1056/NEJM200406033502319. N Engl J Med. 2004. PMID: 15175448 No abstract available.
-
Estrogen plus progestin and colorectal cancer in postmenopausal women.N Engl J Med. 2004 Jun 3;350(23):2417-9; author reply 2417-9. N Engl J Med. 2004. PMID: 15179698 No abstract available.
-
Estrogen plus progestin and colorectal cancer in postmenopausal women.N Engl J Med. 2004 Jun 3;350(23):2417-9; author reply 2417-9. N Engl J Med. 2004. PMID: 15179699 No abstract available.
Similar articles
-
Estrogen-plus-progestin use and mammographic density in postmenopausal women: Women's Health Initiative randomized trial.J Natl Cancer Inst. 2005 Sep 21;97(18):1366-76. doi: 10.1093/jnci/dji279. J Natl Cancer Inst. 2005. PMID: 16174858 Clinical Trial.
-
Estrogen plus progestin and the risk of coronary heart disease.N Engl J Med. 2003 Aug 7;349(6):523-34. doi: 10.1056/NEJMoa030808. N Engl J Med. 2003. PMID: 12904517 Clinical Trial.
-
Menopausal symptoms and treatment-related effects of estrogen and progestin in the Women's Health Initiative.Obstet Gynecol. 2005 May;105(5 Pt 1):1063-73. doi: 10.1097/01.AOG.0000158120.47542.18. Obstet Gynecol. 2005. PMID: 15863546 Clinical Trial.
-
New evidence regarding hormone replacement therapies is urgently required transdermal postmenopausal hormone therapy differs from oral hormone therapy in risks and benefits.Maturitas. 2005 Sep 16;52(1):1-10. doi: 10.1016/j.maturitas.2005.05.003. Maturitas. 2005. PMID: 15963666 Review.
-
Colorectal cancer in women: hormone replacement therapy and chemoprevention.Climacteric. 2012 Jun;15(3):250-5. doi: 10.3109/13697137.2012.659450. Climacteric. 2012. PMID: 22612611 Review.
Cited by
-
Sex hormones and risk of lung and colorectal cancers in women: a Mendelian randomization study.Res Sq [Preprint]. 2024 Apr 10:rs.3.rs-4083598. doi: 10.21203/rs.3.rs-4083598/v1. Res Sq. 2024. PMID: 38659935 Free PMC article. Preprint.
-
Genetic risk impacts the association of menopausal hormone therapy with colorectal cancer risk.Br J Cancer. 2024 Jun;130(10):1687-1696. doi: 10.1038/s41416-024-02638-2. Epub 2024 Apr 1. Br J Cancer. 2024. PMID: 38561434 Free PMC article.
-
Sex differences in colorectal cancer: with a focus on sex hormone-gut microbiome axis.Cell Commun Signal. 2024 Mar 7;22(1):167. doi: 10.1186/s12964-024-01549-2. Cell Commun Signal. 2024. PMID: 38454453 Free PMC article. Review.
-
Delineating the role of nuclear receptors in colorectal cancer, a focused review.Discov Oncol. 2024 Feb 19;15(1):41. doi: 10.1007/s12672-023-00808-x. Discov Oncol. 2024. PMID: 38372868 Free PMC article. Review.
-
Sex differences in colonic gene expression and fecal microbiota composition in a mouse model of obesity-associated colorectal cancer.Sci Rep. 2024 Feb 13;14(1):3576. doi: 10.1038/s41598-024-53861-z. Sci Rep. 2024. PMID: 38347027 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical