Cancer Causes & Control

, Volume 14, Issue 10, pp 979–984 | Cite as

Hormone replacement therapy in relation to survival in women diagnosed with colon cancer

  • Margaret T. Mandelson
  • Diana Miglioretti
  • Polly A. Newcomb
  • Robert Harrison
  • John D. Potter


Introduction: Colorectal cancer is the second leading cause of cancer death among US men and women. A number of studies report that hormone replacement therapy (HRT) reduces the risk of colorectal cancer, but fewer studies have examined the relation between HRT use and survival after diagnosis and none examined this relation by anatomic location of the primary colon tumor. Methods: Data from a cohort of 699 women 50–79 years of age diagnosed with colon cancer between 1980 and 1998 in a large Health Maintenance Organization based in Seattle, Washington were analyzed to examine the relation between HRT use prior to diagnosis and survival. Use of HRT was ascertained from a computerized pharmacy database. Results: HRT use was associated with a 41% reduction in risk of death after adjustment for age, stage, and diagnosis year (p = 0.037). The association between HRT use and colon cancer survival was strongest among women with cancer in the distal colon (hazard rate ratio 0.33, 95% confidence interval, 95% CI: 0.13–0.83), while little or no association between HRT use and survival was observed among women with proximal tumors (HRR 0.78, 95% CI: 0.42–1.44). Conclusions: These findings suggest that HRT use is associated with improved survival from colon cancer. Future observational and laboratory studies should shed light on how hormones may be related to reduced incidence and improved prognosis.

colon cancer disease stage hormone replacement therapy survival prognosis 


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  1. 1.
    Potter JD (1993) Colon cancer-do the nutritional epidemiology, the gut physiology and the molecular biology tell the same story? J Nutr 123: 418-423.Google Scholar
  2. 2.
    Kampman E,Potter JD,Slattery ML,Caan BJ,Edwards S (1997) Hormone replacement therapy, reproductive history, and colon cancer: a multicenter, case-control study in the United States. Cancer Causes Control 8(2): 146-158.Google Scholar
  3. 3.
    Gerhardsson de Verdier M,London S (1992) Reproductive factors, exogenous female hormones, and colorectal cancer by subsite. Cancer Causes Control 3: 355-360.Google Scholar
  4. 4.
    Furner SE,Davis FG,Nelson RL,Haenszel W (1989) A case-control study of large bowel cancer and hormone exposure in women. Cancer Res 49: 4936-4940.Google Scholar
  5. 5.
    Newcomb PA,Storer BE (1995) Postmenopausal hormone use and risk of large-bowel cancer. J Natl Cancer Inst 87: 1067-1071.Google Scholar
  6. 6.
    Jacobs EJ,White E,Weiss NS (1994) Exogenous hormones, reproductive history, and colon cancer (Seattle, Washington, USA). Cancer Causes Control 5: 359-366.Google Scholar
  7. 7.
    Chute CG,Willett WC,Colditz GA,Stampfer MJ,Rosner B,Speizer FE (1991) A prospective study of reproductive history and exogenous estrogens on the risk of colorectal cancer in women. Epidemiol 2: 201-207.Google Scholar
  8. 8.
    Folsom AR,Mink PJ,Sellers TA,Hong CP,Zheng W,Potter JD (1995) Hormonal replacement therapy and morbidity and mortality in a prospective study of postmenopausal women. Am J Public Health 85: 1128-1132.Google Scholar
  9. 9.
    Fernandez E,Vechia CL,Braga C, et al. (1998) Hormone replacement therapy and risk of colon and rectal cancer. Ca Epidemiol Bio Prev 7: 329-333.Google Scholar
  10. 10.
    Grodstein F,Martinez ME,Platz EA, et al. (1998) Postmenopausal hormone use and risk for colorectal cancer and adenoma. Ann Intern Med 128(9): 705-712.Google Scholar
  11. 11.
    Davis FG,Furner SE,Persky V,Koch M (1989) The influence of parity and exogenous female hormones on the risk of colorectal cancer. Int J Epidemiol 43: 587-590.Google Scholar
  12. 12.
    Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results (2002) From the Women's Health Initiative randomized controlled trial. JAMA 288(3): 321-333. Notes: CORPORATE NAME: Writing Group for the Women's Health Initiative Investigators.Google Scholar
  13. 13.
    Slattery ML,Anderson K,Samowitz W,Edwards SL,Curtin K,Caan B,Potter JD (1999) Hormone replacement therapy and improved survival among postmenopausal women diagnosed with colon cancer. Cancer Causes Control 10(5): 467-473.Google Scholar
  14. 14.
    Cox DR (1972) Regression models and life tables (with discussion). J Royal Stat Soc B(34): 86-94. Notes: per Diana Miglioretti.Google Scholar
  15. 15.
    Percy C,Van Holten V,Muir C, eds. (1990) International Classification of Diseases for Oncology. 2nd edn. Geneva: World Health Organization.Google Scholar
  16. 16.
    Psaty BM,Heckbert SR,Atkins D, et al. (1994) The risk of myocardialinfarction associated with the combined use of estrogens and progestins in postmenopausal women. Arch Intern Med 154: 1333-1339.Google Scholar
  17. 17.
    Rutter CM,Mandelson MT,Laya MB,Seger DJ,Taplin S (2001) Changes in breast density associated with initiation, discontinuation, and continuing use of hormone replacement therapy. JAMA 285(2): 171-176.Google Scholar
  18. 18.
    Matthews KA,Kuller LH,Wing RR,Meilahn EN,Plantinga P (1996) Prior to use of estrogen replacement therapy, are users healthier than nonusers? Am J Epidemiol 143: 971-978.Google Scholar
  19. 19.
    Barrett-Connor E (1995) Prevalence, initiation, and continuation of hormone replacement therapy. J Women's Health 4(2): 143-148.Google Scholar
  20. 20.
    McMichael AJ,Potter JD (1980) Reproduction, endogenous and exogenous sex hormones, and colon cancer: a review and hypothesis. J Natl Cancer Inst 65: 1201-1207.Google Scholar
  21. 21.
    Everson GT,McKinley C,Kern F Jr (1991) Mechanisms of gallstone formation in women. Effects of exogenous estrogen (Premarin) and dietary cholesterol on hepatic lipid metabolism. J Clin Invest 87(1): 237-246.Google Scholar
  22. 22.
    Troisi R,Schairer C,Chow W,Schatzkin A,Brinton LA,Fraumeni JF Jr (1997) A prospective study of menopausal hormones and risk of colorectal cancer (United States). Cancer Causes Control 8: 130-138.Google Scholar
  23. 23.
    Slattery ML,Potter JD,Curtin K, et al. (2001) Estrogens reduce and withdrawal of estrogens increase risk of microsatellite instability-positive colon cancer. Cancer Res 61(1): 126-130.Google Scholar
  24. 24.
    Gryfe R,Kim H,Hsieh ET, et al. (2000) Tumor microsatellite instability and clinical outcome in young patients with colorectal cancer. N Engl J Med 342(2): 69-77.Google Scholar
  25. 25.
    Samowitz WS,Curtin K,Ma KN, et al. (2001) Microsatellite instability in sporadic colon cancer is associated with an improved prognosis at the population level. Cancer Epidemiol Biomarkers Prev 10(9): 917-923.Google Scholar
  26. 26.
    Colditz GA (1998) Relationship between estrogen levels, use of hormone replacement therapy, and breast cancer. J Natl Cancer Inst 90(11): 814-823.Google Scholar
  27. 27.
    Issa JPJ,Ottaviano YL,Celano P,Hamilton SR,Davidson NE,Baylin SB (1994) Methylation of the oestrogen receptor CpG island links ageing and neoplasia in human colon. Nat Genet 7: 536-540.Google Scholar
  28. 28.
    Breivik J,Lothe RA,Meling GI,Rognum TO,Borresen-Dale AL,Gaudernack G (1997) Different genetic pathways to proximal and distal colorectal cancer influenced by sex-related factors. Int J Cancer 74(6): 664-669.Google Scholar

Copyright information

© Kluwer Academic Publishers 2003

Authors and Affiliations

  • Margaret T. Mandelson
    • 1
  • Diana Miglioretti
    • 2
  • Polly A. Newcomb
    • 3
  • Robert Harrison
    • 2
  • John D. Potter
    • 3
  1. 1.Center for Health StudiesGroup Health CooperativeSeattleUSA; Cancer Prevention Research Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
  2. 2.Center for Health StudiesGroup Health CooperativeSeattleUSA
  3. 3.Cancer Prevention Research ProgramDivision of Public Health Sciences, Fred Hutchinson Cancer Research CenterSeattleUSA

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