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The influence of hormone therapies on colon and rectal cancer

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Abstract

Exogenous sex hormones seem to play a role in colorectal carcinogenesis. Little is known about the influence of different types or durations of postmenopausal hormone therapy (HT) on colorectal cancer risk. A nationwide cohort of women 50–79 years old without previous cancer (n = 1,006,219) were followed 1995–2009. Information on HT exposures was from the National Prescription Register and updated daily, while information on colon (n = 8377) and rectal cancers (n = 4742) were from the National Cancer Registry. Potential confounders were obtained from other national registers. Poisson regression analyses with 5-year age bands included hormone exposures as time-dependent covariates. Use of estrogen-only therapy and combined therapy were associated with decreased risks of colon cancer (adjusted incidence rate ratio 0.77, 95 % confidence interval 0.68–0.86 and 0.88, 0.80–0.96) and rectal cancer (0.83, 0.72–0.96 and 0.89, 0.80–1.00), compared to never users. Transdermal estrogen-only therapy implied more protection than oral administration, while no significant influence was found of regimen, progestin type, nor of tibolone. The benefit of HT was stronger for long-term hormone users; and hormone users were at lower risk of advanced stage of colorectal cancer, which seems supportive for a causal association between hormone therapy and colorectal cancer.

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Acknowledgments

This study was supported by Grant from the Danish Cancer Society (Grant Number R20 - A1058-10-S2). The sponsor of the study had no role in study design, data collection, data analysis, data interpretation, writing of the report, or the decision to submit the paper for publication.

Author contributions

Guarantor of the article Lina Steinrud Mørch had full access to all study data and takes responsibility for the integrity of the data and the accuracy of the data analyses. Specific author contributions Lina Steinrud Mørch, Susanne Krüger Kjær, Øjvind Lidegaard, Ellen Løkkegaard: Study concept and design. Lina Steinrud Mørch, Øjvind Lidegaard: Acquisition of data. Lina Steinrud Mørch, Susanne Krüger Kjær, Øjvind Lidegaard, Niels Keiding, Ellen Løkkegaard: Analysis and interpretation of data. Lina Steinrud Mørch: Drafting of the manuscript. Lina Steinrud Mørch, Susanne Krüger Kjær, Øjvind Lidegaard, Niels Keiding, Ellen Løkkegaard: Critical revision of the manuscript for important intellectual content and approved the final version of the manuscript. Lina Steinrud Mørch, Niels Keiding: Statistical expertise. Lina Steinrud Mørch: Obtaining funding. Lina Steinrud Mørch, Øjvind Lidegaard, Susanne Krüger Kjær: Study supervision.

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    Authors and Affiliations

    1. Gynecological Clinic, The Juliane Marie Centre, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark

      Lina Steinrud Mørch, Øjvind Lidegaard & Susanne Krüger Kjær

    2. Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Centre, Copenhagen, Denmark

      Lina Steinrud Mørch & Susanne Krüger Kjær

    3. Department of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark

      Niels Keiding

    4. Gynecological-Obstetrical Department, North Zealand Hospital, University of Copenhagen, Hillerød, Denmark

      Ellen Løkkegaard

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    All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that (1) Lina Steinrud Mørch have support from Danish Cancer Society Research Centre for the submitted work; (2) Øjvind Lidegaard has within the last 3 years received honoraria for speeches in pharmaco epidemiological issues all other authors declare that they have no conflicts of interest; (3) their spouses, partners, or children have no financial relationships that may be relevant to the submitted work; and (4) the authors have no non-financial interests that may be relevant to the submitted work.

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    Mørch, L.S., Lidegaard, Ø., Keiding, N. et al. The influence of hormone therapies on colon and rectal cancer. Eur J Epidemiol 31, 481–489 (2016). https://doi.org/10.1007/s10654-016-0116-z

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    • DOI: https://doi.org/10.1007/s10654-016-0116-z

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