Hormone therapy in relation to survival from large bowel cancer

Abstract

Epidemiologic studies of hormone therapy (HT) and colorectal cancer incidence consistently show an inverse association; however, few studies have considered prediagnostic use of HT on mortality among colorectal cancer patients. We evaluated the relationship of HT and survival among a population-based cohort of women with large bowel cancer. Cases (n = 1,297) were newly diagnosed with invasive cancer of the colon or rectum, aged 40–74 years at diagnosis, who were identified by Wisconsin’s statewide registry (1988–1991; 1997–2001) for two case–control studies. Information on HT use and other colorectal cancer risk factors was collected by standardized interview. There were 507 deaths (274 of these attributable to colorectal cancer) over 8.4 years of follow-up through December 2005. Hormone use was not associated with colorectal cancer mortality (adjusted hazard rate ratio = 1.09, confidence interval = 0.81–1.47). Colorectal cancer specific mortality was not associated with HT when considered separately by preparation type. Stage did not modify this relationship. Long-term HT was weakly positively associated with increased mortality after diagnosis of proximal colon, but not distal colon cancer. Because we detected no differences in survival among users of HT compared to non-users, the results suggest that HT use may affect only the incidence of some colorectal tumors.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Potter JD (1999) Colorectal cancer: molecules and populations. J Natl Cancer Inst 91:916–932. doi:10.1093/jnci/91.11.916

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Csizmadi I, Collet JP, Benedetti A, Boivin JF, Hanley JA (2004) The effects of transdermal and oral oestrogen replacement therapy on colorectal cancer risk in postmenopausal women. Br J Cancer 90:76–81. doi:10.1038/sj.bjc.6601438

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Gambacciani M, Monteleone P, Sacco A, Genazzani AR (2003) Hormone replacement therapy and endometrial, ovarian and colorectal cancer. Best Pract Res Clin Endocrinol Metab 17:139–147. doi:10.1016/S1521-690X(02)00086-6

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Grodstein F, Newcomb PA, Stampfer MJ (1999) Postmenopausal hormone therapy and the risk of colorectal cancer: a review and meta-analysis. Am J Med 106:574–582. doi:10.1016/S0002-9343(99)00063-7

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Chlebowski R, Wactawski-Wende J, Ritenbaugh C et al (2004) Estrogen plus progestin and colorectal cancer in postmenopausal women. N Engl J Med 350:991–1004. doi:10.1056/NEJMoa032071

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Prihartono N, Palmer JR, Louik C, Shapiro S, Rosenberg L (2000) A case-control study of use of postmenopausal female hormone supplements in relation to the risk of large bowel cancer. Cancer Epidemiol Biomarkers Prev 9:443–447

    PubMed  CAS  Google Scholar 

  7. 7.

    Rossouw JE, Anderson GL, Prentice RL et al (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA 288:321–333. doi:10.1001/jama.288.3.321

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Newcomb PA, Storer BE (1995) Postmenopausal hormone use and risk of large-bowel cancer. J Natl Cancer Inst 87:1067–1071. doi:10.1093/jnci/87.14.1067

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Newcomb PA, Zheng Y, Chia VM et al (2007) Estrogen plus progestin use, microsatellite instability, and the risk of colorectal cancer in women. Cancer Res 67:7534–7539. doi:10.1158/0008-5472.CAN-06-4275

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Campbell PT, Newcomb P, Gallinger S, Cotterchio M, McLaughlin JR (2007) Exogenous hormones and colorectal cancer risk in Canada: associations stratified by clinically defined familial risk of cancer. Cancer Causes Control 18:723–733. doi:10.1007/s10552-007-9015-7

    PubMed  Article  Google Scholar 

  11. 11.

    Hoffmeister M, Raum E, Winter J, Chang-Claude J, Brenner H (2007) Hormone replacement therapy, body mass, and the risk of colorectal cancer among postmenopausal women from Germany. Br J Cancer 97:1486–1492. doi:10.1038/sj.bjc.6604066

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Heiss G, Wallace R, Anderson GL et al (2008) Health risks and benefits 3 years after stopping randomized treatment with estrogen and progestin. JAMA 299:1036–1045. doi:10.1001/jama.299.9.1036

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Mandelson MT, Miglioretti D, Newcomb PA, Harrison R, Potter JD (2003) Hormone replacement therapy in relation to survival in women diagnosed with colon cancer. Cancer Causes Control 14:979–984. doi:10.1023/B:CACO.0000007970.04094.76

    PubMed  Article  Google Scholar 

  14. 14.

    Slattery ML, Anderson K, Samowitz W et al (1999) Hormone replacement therapy and improved survival among postmenopausal women diagnosed with colon cancer. Cancer Causes Control 10:467–473. doi:10.1023/A:1008974215622

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Calle EE, Miracle-McMahill HL, Thun MJ, Heath CW Jr (1995) Estrogen replacement therapy and risk of fatal colon cancer in a prospective cohort of postmenopausal women. J Natl Cancer Inst 87:517–523. doi:10.1093/jnci/87.7.517

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Ritenbaugh C, Stanford JL, Wu L et al (2008) Conjugated equine estrogens and colorectal cancer incidence and survival: The Women’s Health Initiative Randomized Clinical Trial. Cancer Epidemiol Biomarkers Prev 17:2609–2618. doi:10.1158/1055-9965.EPI-08-0385

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Anderson GL, Limacher M, Assaf AR et al (2004) Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women’s Health Initiative randomized controlled trial. JAMA 291:1701–1712. doi:10.1001/jama.291.14.1701

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Hersh AL, Stefanick ML, Stafford RS (2004) National use of postmenopausal hormone therapy: annual trends and response to recent evidence. JAMA 291:47–53. doi:10.1001/jama.291.1.47

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Nichols HB, Trentham-Dietz A, Hampton JM, Newcomb PA (2005) Oral contraceptive use, reproductive factors, and colorectal cancer risk: findings from Wisconsin. Cancer Epidemiol Biomarkers Prev 14:1212–1218. doi:10.1158/1055-9965.EPI-04-0845

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Doria-Rose VP, Newcomb PA, Morimoto LM, Hampton JM, Trentham-Dietz A (2006) Body mass index and the risk of death following the diagnosis of colorectal cancer in postmenopausal women (United States). Cancer Causes Control 17:63–70. doi:10.1007/s10552-005-0360-0

    PubMed  Article  Google Scholar 

  21. 21.

    Percy C, Van Holten V, Muir C (1990) International classification of diseases for oncology, 2nd edn. World Health Organization, Geneva

    Google Scholar 

  22. 22.

    Calle EE, Terrell DD (1993) Utility of the National Death Index for ascertainment of mortality among cancer prevention study II participants. Am J Epidemiol 137:235–241

    PubMed  CAS  Google Scholar 

  23. 23.

    Breslow NE, Day NE (1987) Statistical methods in cancer research. Volume II-The design and analysis of cohort studies. IARC Scientific Publications, Lyon

    Google Scholar 

  24. 24.

    Chan JA, Meyerhardt JA, Chan AT et al (2006) Hormone replacement therapy and survival after colorectal cancer diagnosis. J Clin Oncol 24:5680–5686. doi:10.1200/JCO.2006.08.0580

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    Persson I, Yuen J, Bergkvist L, Schairer C (1996) Cancer incidence and mortality in women receiving estrogen and estrogen-progestin replacement therapy—long-term follow-up of a Swedish cohort. Int J Cancer 67:327–332. doi:10.1002/(SICI)1097-0215(19960729)67:3<327::AID-IJC4>3.0.CO;2-T

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Sturgeon SR, Schairer C, Brinton LA, Pearson T, Hoover RN (1995) Evidence of a healthy estrogen user survivor effect. Epidemiology 6:227–231

    PubMed  CAS  Google Scholar 

  27. 27.

    Zielinski SL (2005) Hormone replacement therapy for breast cancer survivors: an answered question? J Natl Cancer Inst 97:955

    PubMed  Article  Google Scholar 

  28. 28.

    Campbell-Thompson M, Lynch IJ, Bhardwaj B (2001) Expression of estrogen receptor (ER) subtypes and ERbeta isoforms in colon cancer. Cancer Res 61:632–640

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

Financial support: This work was supported in part by the Alcoholic Beverage Medical Research Foundation and National Institute of Health grant CA47147.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Polly A. Newcomb.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Newcomb, P.A., Chia, V.M., Hampton, J.M. et al. Hormone therapy in relation to survival from large bowel cancer. Cancer Causes Control 20, 409–416 (2009). https://doi.org/10.1007/s10552-008-9255-1

Download citation

Keywords

  • Hormone therapy
  • Colorectal cancer
  • Mortality