Hormone replacement therapy and risk of lung cancer.
Article Type: Clinical report
Subject: Lung cancer (Risk factors)
Lung cancer (Demographic aspects)
Lung cancer (Research)
Hormone therapy (Complications and side effects)
Hormone therapy (Research)
Pub Date: 05/01/2010
Publication: Name: Reproductive Health Matters Publisher: Reproductive Health Matters Audience: General Format: Magazine/Journal Subject: Family and marriage; Health; Women's issues/gender studies Copyright: COPYRIGHT 2010 Reproductive Health Matters ISSN: 0968-8080
Issue: Date: May, 2010 Source Volume: 18 Source Issue: 35
Topic: Event Code: 310 Science & research
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 236247753
Full Text: The Women's Health Initiative (WHI) trial of hormone replacement therapy (HRT) was a randomised, double-blind, placebo-controlled trial undertaken in 40 centres in the US. 16,608 postmenopausal women aged 50-79 were randomly assigned to placebo (n=8,102) or a combination of conjugated equine oestrogen and medroxyprogesterone acetate (n=8,506). The trial was stopped early when health risks of HRT, including a higher risk of cancer, were found to exceed benefits. Results suggested more deaths from lung cancer and so researchers undertook a post-hoc analysis of all lung cancers diagnosed in the trial. After a mean of 5.6 years of treatment and 2.4 years of additional follow-up, the women in the treatment arm had a non-significant increase in the incidence of lung cancer (109 women diagnosed in HRT group compared with 85 in placebo group: incidence per year 0.16% versus 0.13%; hazard ratio [HR] 1.23, p=0.16). However, more women died from lung cancer in the treatment group compared to the placebo group (73 versus 40 deaths; 0.11% versus 0.06%; HR 1.71, p=0.0l), mainly as a result of more deaths from non-small-cell lung cancer (62 versus 31 deaths; 0.09% versus 0-05%; HR 1-87, p=0.004). Incidence and mortality rates of small-cell lung cancer were similar between groups. (1)

An accompanying comment explains that previous analyses on this subject--all retrospective--give conflicting results, and that these are the first randomised trial data. These latest findings dispel the notion that progesterone is protective against lung cancer, and show that HRT might actually increase the incidence. The implications are that HRT should be discontinued once lung cancer is diagnosed, and it should be avoided in women at high risk of developing lung cancer, e.g. smokers. The findings seriously question whether HRT has any role in medicine today. It is difficult to presume that the benefits of routine HRT use for menopausal symptoms outweigh the increased risks of mortality. (2)

(1.) Chlebowski RT, Schwartz AG and H Wakelee H, el al. Oestrogen plus progestin and lung cancer in postmenopausal women (Women's Health Initiative trial): a post-hoc analysis of a randomised controlled trial. Lancet 2009;374:1243-51.

(2.) Ganti AK. Another nail in the coffin for hormone-replacement therapy? Lancet 2009;374:1217-18.
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