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What is behind the fear of cancer during menopausal hormone therapy in China?

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

The application of menopausal hormone therapy (MHT) is generally restricted most likely due to limited prescriptions by doctors. Fear of cancer risk may be a critical factor. We investigated the views of Chinese obstetricians and gynecologists on the relationship between hormone therapy and cancer risk.

Methods

A self-administered web-based nationwide cross-sectional questionnaire.

Results

In total, 5243 medical workers responded to the questionnaire (response rate 94.5%); 4995 were certified obstetricians and gynecologists. Most were aged 36–55 years (70.9%), had > 10 years of working experience (68.5%), and worked at tertiary (34.8%) and secondary hospitals (49.1%); 70% of the clinicians were aware of the endometrial cancer risk caused by estrogen, and 20% considered progestogen to cause the same risk. Regarding breast cancer, while 67.9 and 74.8% of the clinicians viewed natural and synthetic estrogens as risk factors, respectively, only 41.7% identified the carcinogenic effect of progestins as higher than that of progesterone (26.7%). Approximately 75% of the participants believed synthetic estrogens and progestins constituted a risk for ovarian cancer (higher than the percentages for their natural counterparts); 13.0–21.1% of the respondents were worried about choriocarcinoma due to hormone treatment. Finally, 86.8% of obstetricians and gynecologists claimed to have poor knowledge regarding this field.

Conclusion

Misconceptions and a lack of knowledge in this regard may result in the fear of cancer and could be the underlying causes of limited MHT prescriptions. We believe that scientific research, continued education, and the media all have roles to play in changing preconceived ideas regarding MHT prescriptions.

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Data availability

Data analyzed in this study are included within the article and its supplementary files.

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This study did not generate any unique code.

References

  1. Avis N, Crawford S, Greendale G, Bromberger J, Everson-Rose S, Gold E, Hess R, Joffe H, Kravitz H, Tepper P, Thurston R (2015) Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern Med 175(4):531–539. https://doi.org/10.1001/jamainternmed.2014.8063

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ryu K, Park H, Kim Y, Yi K, Shin J, Hur J, Kim T (2020) Comparison of various menopausal symptoms and risk factor analysis in Korean women according to stage of menopause. Maturitas 140:41–48. https://doi.org/10.1016/j.maturitas.2020.05.023

    Article  PubMed  Google Scholar 

  3. Stevenson J (2011) A woman’s journey through the reproductive, transitional and postmenopausal periods of life: impact on cardiovascular and musculo-skeletal risk and the role of estrogen replacement. Maturitas 70(2):197–205. https://doi.org/10.1016/j.maturitas.2011.05.017

    Article  PubMed  Google Scholar 

  4. de Villiers T, Hall J, Pinkerton J, Pérez S, Rees M, Yang C, Pierroz D (2016) Revised global consensus statement on menopausal hormone therapy. Maturitas 91:153–155. https://doi.org/10.1016/j.maturitas.2016.06.001

    Article  PubMed  Google Scholar 

  5. Schierbeck LL, Rejnmark L, Tofteng CL, Stilgren L, Eiken P, Mosekilde L, Køber L, Jensen JE (2012) Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. BMJ 345:e6409. https://doi.org/10.1136/bmj.e6409

    Article  CAS  PubMed  Google Scholar 

  6. Cagnacci A, Venier M (2019) The controversial history of hormone replacement therapy. Medicina (Kaunas). https://doi.org/10.3390/medicina55090602

    Article  Google Scholar 

  7. Ziel HK, Finkle WD (1975) Increased risk of endometrial carcinoma among users of conjugated estrogens. N Engl J Med 293(23):1167–1170. https://doi.org/10.1056/nejm197512042932303

    Article  CAS  PubMed  Google Scholar 

  8. Beral V, Gaitskell K, Hermon C, Moser K, Reeves G, Peto R (2015) Menopausal hormone use and ovarian cancer risk: individual participant meta-analysis of 52 epidemiological studies. Lancet 385(9980):1835–1842. https://doi.org/10.1016/s0140-6736(14)61687-1

    Article  CAS  PubMed  Google Scholar 

  9. Collaborative Group on Hormonal Factors in Breast Cancer (2019) Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence. Lancet 394(10204):1159–1168. https://doi.org/10.1016/s0140-6736(19)31709-x

    Article  CAS  PubMed Central  Google Scholar 

  10. Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SA, Howard BV, Johnson KC, Kotchen JM, Ockene J, Writing Group for the Women’s Health Initiative Investigators (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the women’s health initiative randomized controlled trial. JAMA 288(3):321–333. https://doi.org/10.1001/jama.288.3.321

    Article  CAS  PubMed  Google Scholar 

  11. Hodis HN, Mack WJ (2011) A “window of opportunity:” the reduction of coronary heart disease and total mortality with menopausal therapies is age- and time-dependent. Brain Res 1379:244–252. https://doi.org/10.1016/j.brainres.2010.10.076

    Article  CAS  PubMed  Google Scholar 

  12. Shapiro S, de Villiers TJ, Pines A, Sturdee DW, Baber RJ, Panay N, Stevenson JC, Mueck AO, Burger HG (2014) Risks and benefits of hormone therapy: has medical dogma now been overturned? Climacteric 17(3):215–222. https://doi.org/10.3109/13697137.2014.905529

    Article  CAS  PubMed  Google Scholar 

  13. Manson JE, Chlebowski RT, Stefanick ML, Aragaki AK, Rossouw JE, Prentice RL, Anderson G, Howard BV, Thomson CA, LaCroix AZ, Wactawski-Wende J, Jackson RD, Limacher M, Margolis KL, Wassertheil-Smoller S, Beresford SA, Cauley JA, Eaton CB, Gass M, Hsia J, Johnson KC, Kooperberg C, Kuller LH, Lewis CE, Liu S, Martin LW, Ockene JK, O’Sullivan MJ, Powell LH, Simon MS, Van Horn L, Vitolins MZ, Wallace RB (2013) Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the women’s health Initiative randomized trials. JAMA 310(13):1353–1368. https://doi.org/10.1001/jama.2013.278040

    Article  CAS  PubMed  Google Scholar 

  14. Seshadri L (2006) Long-term hormone therapy for perimenopausal and postmenopausal women: RHL commentary. The WHO Reproductive Health Library

    Google Scholar 

  15. Blümel JE, Chedraui P, Barón G, Benítez Z, Flores D, Espinoza MT, Gomez G, González E, Hernández L, Lima S, Martino M, Montaño A, Monterrosa A, Mostajo D, Ojeda E, Onatra W, Robles C, Saavedra J, Sánchez H, Tserotas K, Vallejo MS, Vallejo C (2014) A multicentric study regarding the use of hormone therapy during female mid-age (REDLINC VI). Climacteric 17(4):433–441. https://doi.org/10.3109/13697137.2014.882305

    Article  CAS  PubMed  Google Scholar 

  16. Wang Y, Yang X, Li X, He X, Zhao Y (2014) Knowledge and personal use of menopausal hormone therapy among Chinese obstetrician-gynecologists: results of a survey. Menopause 21(11):1190–1196. https://doi.org/10.1097/gme.0000000000000233

    Article  PubMed  Google Scholar 

  17. Lin L, Feng P, Yu Q (2020) Attitude and knowledge for menopause management among health professionals in mainland China. Climacteric. https://doi.org/10.1080/13697137.2020.1775809

    Article  PubMed  Google Scholar 

  18. Danckers L, Blumel JE, Witis S, Vallejo MS, Tserotas K, Sanchez H, Salinas C, Saavedra J, Rojas JA, Onatra W, Ojeda E, Mostajo D, Morera F, Monterrosa A, Montano A, Meruvia N, Martino M, Martinez J, Lima S, Gonzalez E, Gomez G, Espinoza MT, Castillo O, Campostrini B, Calle A, Broutin G, Bencosme A, Arteaga E, Ayala F, Chedraui P (2016) Personal and professional use of menopausal hormone therapy among gynecologists: a multinational study (REDLINC VII). Maturitas 87:67–71. https://doi.org/10.1016/j.maturitas.2016.02.015

    Article  PubMed  Google Scholar 

  19. Baber R, Panay N, Fenton A (2016) 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric 19(2):109–150. https://doi.org/10.3109/13697137.2015.1129166

    Article  CAS  PubMed  Google Scholar 

  20. L’Hermite M (2013) HRT optimization, using transdermal estradiol plus micronized progesterone a safer HRT. Climacteric. https://doi.org/10.3109/13697137.2013.808563

    Article  PubMed  Google Scholar 

  21. Nielsen M, Raundahl J, Pettersen P, Loog M, Karemore G, Karsdal M, Christiansen C (2009) Low-dose transdermal estradiol induces breast density and heterogeneity changes comparable to those of raloxifene. Menopause 16(4):785–791. https://doi.org/10.1097/gme.0b013e318199d07f

    Article  PubMed  Google Scholar 

  22. Reid R, Abramson BL, Blake J, Desindes S, Dodin S, Johnston S, Rowe T, Sodhi N, Wilks P, Wolfman W, Soares CN, Fortier M, Reid R, Abramson BL, Blake J, Desindes S, Dodin S, Graves L, Guthrie B, Khan A, Johnston S, Rowe T, Sodhi N, Wilks P, Wolfman W (2014) Managing menopause abstract and summary statement. J Obstet Gynaecol Can 36(9):S1–S5. https://doi.org/10.1016/s1701-2163(15)30456-4

    Article  Google Scholar 

  23. The NAMS 2017 Hormone Therapy Position Statement Advisory Panel (2017) The 2017 hormone therapy position statement of the north American menopause society. Menopause 24(7):728–753. https://doi.org/10.1097/GME.0000000000000921

    Article  Google Scholar 

  24. Menopause Subgroup, Chinese Society of Obstetrics and Gynecology, Chinese Medical Association (2018) Chinese guideline on menopause management and menopause hormone therapy. Zhonghua Fu Chan Ke Za Zhi 53(11):729–739

    Google Scholar 

  25. Barry JA, Azizia MM, Hardiman PJ (2014) Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update 20(5):748–758. https://doi.org/10.1093/humupd/dmu012

    Article  PubMed  PubMed Central  Google Scholar 

  26. Gompel A (2020) Progesterone and endometrial cancer. Best Pract Res Clin Obstet Gynaecol. https://doi.org/10.1016/j.bpobgyn.2020.05.003

    Article  PubMed  Google Scholar 

  27. Davies C, Pan H, Godwin J, Gray R, Arriagada R, Raina V, Abraham M, Medeiros Alencar VH, Badran A, Bonfill X, Bradbury J, Clarke M, Collins R, Davis SR, Delmestri A, Forbes JF, Haddad P, Hou MF, Inbar M, Khaled H, Kielanowska J, Kwan WH, Mathew BS, Mittra I, Müller B, Nicolucci A, Peralta O, Pernas F, Petruzelka L, Pienkowski T, Radhika R, Rajan B, Rubach MT, Tort S, Urrútia G, Valentini M, Wang Y, Peto R (2013) Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial. Lancet 381(9869):805–816. https://doi.org/10.1016/s0140-6736(12)61963-1

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. LaCroix A, Chlebowski R, Manson J, Aragaki A, Johnson K, Martin L, Margolis K, Stefanick M, Brzyski R, Curb J, Howard B, Lewis C, Wactawski-Wende J (2011) Health outcomes after stopping conjugated equine estrogens among postmenopausal women with prior hysterectomy: a randomized controlled trial. JAMA 305(13):1305–1314. https://doi.org/10.1001/jama.2011.382

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Manson J, Chlebowski R, Stefanick M, Aragaki A, Rossouw J, Prentice R, Anderson G, Howard B, Thomson C, LaCroix A, Wactawski-Wende J, Jackson R, Limacher M, Margolis K, Wassertheil-Smoller S, Beresford S, Cauley J, Eaton C, Gass M, Hsia J, Johnson K, Kooperberg C, Kuller L, Lewis C, Liu S, Martin L, Ockene J, O’Sullivan M, Powell L, Simon M, Van Horn L, Vitolins M, Wallace R (2013) Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the women’s health initiative randomized trials. JAMA 310(13):1353–1368. https://doi.org/10.1001/jama.2013.278040

    Article  CAS  PubMed  Google Scholar 

  30. Morch LS, Skovlund CW, Hannaford PC, Iversen L, Fielding S, Lidegaard O (2017) Contemporary hormonal contraception and the risk of breast cancer. N Engl J Med 377(23):2228–2239. https://doi.org/10.1056/NEJMoa1700732

    Article  PubMed  Google Scholar 

  31. Marchbanks PA, McDonald JA, Wilson HG, Folger SG, Mandel MG, Daling JR, Bernstein L, Malone KE, Ursin G, Strom BL, Norman SA, Wingo PA, Burkman RT, Berlin JA, Simon MS, Spirtas R, Weiss LK (2002) Oral contraceptives and the risk of breast cancer. N Engl J Med 346(26):2025–2032. https://doi.org/10.1056/NEJMoa013202

    Article  CAS  PubMed  Google Scholar 

  32. Asi N, Mohammed K, Haydour Q, Gionfriddo M, Vargas O, Prokop L, Faubion S, Murad M (2016) Progesterone vs synthetic progestins and the risk of breast cancer: a systematic review and meta-analysis. Syst Rev 5(1):121. https://doi.org/10.1186/s13643-016-0294-5

    Article  PubMed  PubMed Central  Google Scholar 

  33. Hosford SR, Shee K, Wells JD, Traphagen NA, Fields JL, Hampsch RA, Kettenbach AN, Demidenko E, Miller TW (2019) Estrogen therapy induces an unfolded protein response to drive cell death in ER+ breast cancer. Mol Oncol 13(8):1778–1794. https://doi.org/10.1002/1878-0261.12528

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Joshi P, Jackson H, Beristain A, Di Grappa M, Mote P, Clarke C, Stingl J, Waterhouse P, Khokha R (2010) Progesterone induces adult mammary stem cell expansion. Nature 465(7299):803–807. https://doi.org/10.1038/nature09091

    Article  CAS  PubMed  Google Scholar 

  35. Chlebowski RT, Anderson GL (2012) Changing concepts: menopausal hormone therapy and breast cancer. J Natl Cancer Inst 104(7):517–527. https://doi.org/10.1093/jnci/djs014

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Mirkin S, Wong B, Archer D (2005) Effect of 17 beta-estradiol, progesterone, synthetic progestins, tibolone, and tibolone metabolites on vascular endothelial growth factor mRNA in breast cancer cells. Fertil Steril 84(2):485–491. https://doi.org/10.1016/j.fertnstert.2005.01.129

    Article  CAS  PubMed  Google Scholar 

  37. Lumsden M (2016) The NICE Guideline - Menopause: diagnosis and management. Climact J Int Menopause Soc 19(5):426–429. https://doi.org/10.1080/13697137.2016.1222483

    Article  CAS  Google Scholar 

  38. Malvezzi M, Carioli G, Rodriguez T, Negri E, La Vecchia C (2016) Global trends and predictions in ovarian cancer mortality. Ann Oncol 27(11):2017–2025. https://doi.org/10.1093/annonc/mdw306

    Article  CAS  PubMed  Google Scholar 

  39. Mørch LS, Løkkegaard E, Andreasen AH, Krüger-Kjaer S, Lidegaard O (2009) Hormone therapy and ovarian cancer. JAMA 302(3):298–305. https://doi.org/10.1001/jama.2009.1052

    Article  PubMed  Google Scholar 

  40. Simin J, Tamimi R, Lagergren J, Adami HO, Brusselaers N (2017) Menopausal hormone therapy and cancer risk: an overestimated risk? Eur J Cancer 84:60–68. https://doi.org/10.1016/j.ejca.2017.07.012

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank all the obstetricians and gynecologists for providing their valuable views. We also thank the China Maternal and Child Health Association, Society of Gynecological Endocrinology, for supporting our survey. We would also like to thank Editage (www.editage.cn) for English language editing.

Funding

No financial support was received for this study.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Dongcheng District, Beijing, 100730, China

    Yanfang Wang & Aijun Sun

  2. Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Hebei, 050000, China

    Wei Wang

  3. The Second Affiliated Hospital of Nanchang University, Jiangxi, 330006, China

    Ying Feng

  4. Xinhui Maternity and Children’s Hospital, Guangxi, 529100, China

    Zhangyun Tan & Yinqing Zhao

  5. Liuzhou Maternity and Child Healthcare Hospital, Guangxi, 545001, China

    Xiaomin Yang

  6. Zhongda Hospital Southeast University, Jiangsu, 210009, China

    Danhong Peng

  7. Women and Children’s Hospital of Jinzhou, Liaoning, 121000, China

    Han Dong

  8. The Affiliated Hospital of Qingdao University, Shandong, 266500, China

    Qingmei Zheng

  9. Department of Gynecology, Guangzhou Women and Children’s Medical Center, Guangdong, 510000, China

    Xiaoqin Zeng

  10. Hunan Provincial Maternal and Child Health Care Hospital, Hunan, 410008, China

    Ying Zou

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  1. Yanfang Wang
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  2. Wei Wang
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Contributions

YFW: research plan implementation and questionnaire design and formal analysis, conceptualization, and writing of the manuscript; WW: distribution, completion, and collection of questionnaires; formal analysis, conceptualization, and writing of the manuscript; review of the manuscript; and organization and cooperation of the national survey; YF, ZYT, and XMY: distribution, completion, and collection of questionnaires and review of the manuscript; DHP, YQZ, HD, QMZ, XQZ, and YZ: distribution, completion, and collection of questionnaires; AJS: research plan implementation and questionnaire design and organization and cooperation of the national survey.

Corresponding author

Correspondence to Aijun Sun.

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The authors declared no conflicts of interest.

Ethical approval

The study was reviewed and approved by the Ethics Committee of Peking Union Medical College Hospital (Ethical code number: S-k1189-1; date of approval: May 08, 2020) and is in accordance with the Declaration of Helsinki.

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Wang, Y., Wang, W., Feng, Y. et al. What is behind the fear of cancer during menopausal hormone therapy in China?. Arch Gynecol Obstet 304, 1353–1361 (2021). https://doi.org/10.1007/s00404-021-06052-4

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