Dataset Information

Menopausal hormone therapy prior to the diagnosis of ovarian cancer is associated with improved survival.

ABSTRACT:

Purpose

Prior studies of menopausal hormone therapy (MHT) and ovarian cancer survival have been limited by lack of hormone regimen detail and insufficient sample sizes. To address these limitations, a comprehensive analysis of 6419 post-menopausal women with pathologically confirmed ovarian carcinoma was conducted to examine the association between MHT use prior to diagnosis and survival.

Methods

Data from 15 studies in the Ovarian Cancer Association Consortium were included. MHT use was examined by type (estrogen-only (ET) or estrogen+progestin (EPT)), duration, and recency of use relative to diagnosis. Cox proportional hazards models were used to estimate the association between hormone therapy use and survival. Logistic regression and mediation analysis was used to explore the relationship between MHT use and residual disease following debulking surgery.

Results

Use of ET or EPT for at least five years prior to diagnosis was associated with better ovarian cancer survival (hazard ratio, 0.80; 95% CI, 0.74 to 0.87). Among women with advanced stage, high-grade serous carcinoma, those who used MHT were less likely to have any macroscopic residual disease at the time of primary debulking surgery (p for trend <0.01 for duration of MHT use). Residual disease mediated some (17%) of the relationship between MHT and survival.

Conclusions

Pre-diagnosis MHT use for 5+ years was a favorable prognostic factor for women with ovarian cancer. This large study is consistent with prior smaller studies, and further work is needed to understand the underlying mechanism.

SUBMITTER: Brieger KK

PROVIDER: S-EPMC7487048 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Publications

Menopausal hormone therapy prior to the diagnosis of ovarian cancer is associated with improved survival.

Brieger Katharine K KK Peterson Siri S Lee Alice W AW Mukherjee Bhramar B Bakulski Kelly M KM Alimujiang Aliya A Anton-Culver Hoda H Anglesio Michael S MS Bandera Elisa V EV Berchuck Andrew A Bowtell David D L DDL Chenevix-Trench Georgia G Cho Kathleen R KR Cramer Daniel W DW DeFazio Anna A Doherty Jennifer A JA Fortner Renée T RT Garsed Dale W DW Gayther Simon A SA Gentry-Maharaj Aleksandra A Goode Ellen L EL Goodman Marc T MT Harris Holly R HR Høgdall Estrid E Huntsman David G DG Shen Hui H Jensen Allan A Johnatty Sharon E SE Jordan Susan J SJ Kjaer Susanne K SK Kupryjanczyk Jolanta J Lambrechts Diether D McLean Karen K Menon Usha U Modugno Francesmary F Moysich Kirsten K Ness Roberta R Ramus Susan J SJ Richardson Jean J Risch Harvey H Rossing Mary Anne MA Trabert Britton B Wentzensen Nicolas N Ziogas Argyrios A Terry Kathryn L KL Wu Anna H AH Hanley Gillian E GE Pharoah Paul P Webb Penelope M PM Pike Malcolm C MC Pearce Celeste Leigh CL

Gynecologic oncology 20200706 3

<h4>Purpose</h4>Prior studies of menopausal hormone therapy (MHT) and ovarian cancer survival have been limited by lack of hormone regimen detail and insufficient sample sizes. To address these limitations, a comprehensive analysis of 6419 post-menopausal women with pathologically confirmed ovarian carcinoma was conducted to examine the association between MHT use prior to diagnosis and survival.<h4>Methods</h4>Data from 15 studies in the Ovarian Cancer Association Consortium were included. MHT ...[more]

PMID: 32641237

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Project description:BackgroundMenopausal hormone therapy (MHT) is associated with an increased risk of postmenopausal breast cancer, predominantly the luminal A-like subtype. The impact of MHT on deaths from breast cancer subtypes is less understood. This study aimed to explore associations between MHT use and the incidence, mortality, and survival of intrinsic-like breast cancer subtypes.MethodsData from 160,881 participants with self-reported MHT use from the prospective Norwegian Women and Cancer Study were analyzed. Among them, 7,844 incident breast cancer cases, and 721 breast cancer-specific deaths occurred. Cox proportional hazard regression was performed to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for the association between MHT use and the incidence, mortality, and survival of breast cancer subtypes.ResultsMHT use was associated with increased risk of overall, luminal A-like, and luminal B-like breast cancer, with respective HRs of 1.44 (95% CI 1.36-1.52), 1.41 (95% CI 1.31-1.52), and 1.23 (95% CI 1.09-1.40) among current estrogen-progestin therapy (EPT) users compared with never users. The risk increased by 4%, 4%, and 2% per year of EPT use for overall, luminal A-like, and luminal B-like breast cancers, respectively. MHT use was also associated with increased risk of overall and luminal A-like breast cancer mortality, with HRs 1.61% (95% CI 1.36-1.91) and 2.15% (95% CI 1.51-3.05) increased risk among current EPT users compared with non-users. Among patients with breast cancer, pre-diagnostic MHT use was not associated with worse survival from overall breast cancer but was inversely associated with survival from triple-negative breast cancer (TNBC; HR death 0.41; 95% CI 0.24-0.73 among current users). Results varied significantly according to tumor subtype (pheterogeneity = 0.02).ConclusionsOur study suggests that MHT use increases the risk of incident and fatal overall and luminal A-like, and incident luminal B-like breast cancer but does not decrease overall survival among patients with breast cancer. Further research is needed to elucidate the mechanisms underlying MHT use and breast cancer lethality, and to explore whether MHT use among patients with TNBC is indeed free from harm.

Dataset Information

Menopausal hormone therapy prior to the diagnosis of ovarian cancer is associated with improved survival.

Purpose

Methods

Results

Conclusions

Publications

Menopausal hormone therapy prior to the diagnosis of ovarian cancer is associated with improved survival.

Similar Datasets

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