Advertisement

Cancer Causes & Control

, Volume 14, Issue 2, pp 195–201 | Cite as

Patterns of postmenopausal progestin use with estrogen in relation to endometrial cancer (United States)

  • Polly A. NewcombEmail author
  • Amy Trentham-Dietz
Article

Abstract

Objective: To investigate the risk of endometrial cancer associated with various regimens of postmenopausal hormone therapy. Methods: Data from a population-based case–control study were analysed that included 591 women newly diagnosed with endometrial cancer, aged 40–79, and who were reported to Wisconsin's statewide tumor registry in 1991–1994. Similarly aged population controls (n = 2045) were randomly selected from lists of licensed drivers and Medicare beneficiaries. Information on hormone use and other factors was obtained through telephone interviews. Results: Ever use of estrogen–progestin hormones was associated with increased endometrial cancer compared to women who had never used hormones; the increase per year of use was 7% (95% confidence interval 1–13%). Both cyclic (<10 days per month) and continuous progestin used with estrogen were associated with comparable twofold increases in risk relative to non-users. There was no increased risk associated with progestin used for 10–21 days per month. Conclusions: Both continuous and cyclic progestin regimens are associated with a much lower risk of endometrial cancer than estrogen alone. However, many women using these regimens remain at significantly increased risk of endometrial cancer.

endometrial neoplasms estrogen estrogen replacement therapy postmenopause progestin 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Pike MC,Peters RK,Cozen W, et al. (1997) Estrogen-progestin replacement therapy and endometrial cancer. J Natl Cancer Inst 89: 1110-1116.Google Scholar
  2. 2.
    Persson I,Adami HO,Bergkvist L, et al. (1989) Risk of endometrial cancer after treatment with oestrogens alone or in conjunction with progestogens: results of a prospective study. Brit Med J 298: 147-151.Google Scholar
  3. 3.
    Voigt LF,Weiss NS,Chu J,Daling JR,McKnight B,van Belle G (1991) Progestagen supplementation of exogenous oestrogens and risk of endometrial cancer. Lancet 338: 274-277.Google Scholar
  4. 4.
    Weiderpass E,Adami HO,Baron JA, et al. (1999) Risk of endometrial cancer following estrogen replacement with and without progestins. J Natl Cancer Inst 91: 1131-1137.Google Scholar
  5. 5.
    Jick SS,Walker AM,Jick H (1993) Estrogens, progesterone, and endometrial cancer. Epidemiol 4: 20-24.Google Scholar
  6. 6.
    Grady D,Gebretsadik T,Kerlikowske K,Ernster V,Petitti D (1995) Hormone replacement therapy and endometrial cancer risk: a meta-analysis. Obst Gynecol 85: 304-313.Google Scholar
  7. 7.
    The Writing Group for the PEPI Trial (1996) Effects of hormone replacement therapy on endometrial histology in postmenopausal women. The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial. JAMA 275: 370-375.Google Scholar
  8. 8.
    Woodruff JD,Pickar JH (1994) Incidence of endometrial hyperplasia in postmenopausal women taking conjugated estrogens (Premarin) with medroxyprogesterone acetate or conjugated estrogens alone. The Menopause Study Group. Am J Obstet Gynecol 170: 1213-1223.Google Scholar
  9. 9.
    Beresford SA,Weiss NS,Voigt LF,McKnight B (1997) Risk of endometrial cancer in relation to use of oestrogen combined with cyclic progestagen therapy in postmenopausal women. Lancet 349: 458-461.Google Scholar
  10. 10.
    Newcomb PA,Egan KM,Titus-Ernstoff L, et al. (1999) Lactation in relation to postmenopausal breast cancer. Am J Epidemiol 150: 174-182.Google Scholar
  11. 11.
    Beresford SA,Coker AL (1989) Pictorially assisted recall of past hormone use in case-control studies. Am J Epidemiol 130: 202-205.Google Scholar
  12. 12.
    Breslow NE,Day NE (1980) Statistical methods in cancer research. Volume I-The analysis of case-control studies. IARC Scientific Publications (Lyon), 5-338.Google Scholar
  13. 13.
    Grady D,Ernster VL (1997) Hormone replacement therapy and endometrial cancer: are current regimens safe? J Natl Cancer Inst 89: 1088-1089.Google Scholar
  14. 14.
    Rubin GL,Peterson HB,Lee NC,Maes EF,Wingo PA,Becker S (1990) Estrogen replacement therapy and the risk of endometrial cancer: remaining controversies. Am J Obstet Gynecol 162: 148-154.Google Scholar
  15. 15.
    Green PK,Weiss NS,McKnight B,Voigt LF,Beresford SA (1996) Risk of endometrial cancer following cessation of menopausal hormone use (Washington, United States). Cancer Causes Control 7: 575-580.Google Scholar
  16. 16.
    Hirvonen E (1996) Progestins. Maturitas 23(Suppl 1): S13-S18.Google Scholar
  17. 17.
    Stanczyk FZ (1994) Stucture-function relationships, potency, and pharmacokinetcis of progestogens. In: Lobo R. ed. Treatment of Postmenopausal Women: Basic and Clinical Aspects, New York: Raven Press, pp. 69-80.Google Scholar
  18. 18.
    Writing Group for the Women's Health Initiative Investigators (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women. JAMA 288: 321-333.Google Scholar
  19. 19.
    Lane G,Siddle NC,Ryder TA,Pryse-Davies J,King RJ,Whitehead MI (1986) Is Provera the ideal progestogen for addition to postmenopausal estrogen therapy? Fertil Steril 45: 345-352.Google Scholar
  20. 20.
    Paterson ME,Wade-Evans T,Sturdee DW,Thom MH,Studd JW (1980) Endometrial disease after treatment with oestrogens and progestogens in the climacteric. Brit Med J 280: 822-824.Google Scholar
  21. 21.
    Key TJ,Pike MC (1988) The dose-effect relationship between ‘unopposed’ oestrogens and endometrial mitotic rate: its central role in explaining and predicting endometrial cancer risk. Brit J Cancer 57: 205-212.Google Scholar
  22. 22.
    Greendale GA,James MK,Espeland MA,Barrett-Connor E (1997) Can we measure prior postmenopausal estrogen/progestin use? The Postmenopausal Estrogen/Progestin Interventions Trial. The PEPI Investigators. Am J Epidemiol 146: 763-770.Google Scholar
  23. 23.
    Jain MG,Rohan TE,Howe GR (1999) Agreement of self-reported use of menopausal hormone replacement therapy with physician reports. Epidemiol 10: 260-263.Google Scholar
  24. 24.
    Goodman MT,Nomura AM,Wilkens LR,Kolonel LN (1990) Agreement between interview information and physician records on history of menopausal estrogen use. Am J Epidemiol 131: 815-825.Google Scholar

Copyright information

© Kluwer Academic Publishers 2003

Authors and Affiliations

  1. 1.Fred Hutchinson Cancer Research CenterSeattleUSA
  2. 2.University of Wisconsin Comprehensive Cancer CenterMadisonUSA

Personalised recommendations