HER2 Support Group Forums - View Single Post - Hormone Therapy Accelerates Breast Cancer Progression And Raises Risk

gdpawel · 10-20-2010, 06:16 PM

It is being said by some, what is being (erroneously) disseminated in the media is the following message: “Not only does prolonged use of hormone replacement therapy raise the risk of breast cancer, new research finds, but it also ups the risk for more severe forms of the disease and increases a woman’s chances of dying.”

This most recent Women's Health Initiative paper only looks at (1) breast cancer mortality and (2) all cause mortality after a diagnosis of breast cancer. It does not report all cause mortality. Therefore, it cannot be stated that HRT “increases a woman’s chances of dying.”

Risks and benefits must be individualized. Thin post menopausal women, with physically active lifestyles, non-hyperdense breasts, low to negligible alcohol consumption, lack of family history, negative mammograms, low fat diets, no tobacco use, low risk of coronary artery disease, and severe osteopenia are at high risk for high lethality hip fractures, but at low risk for breast cancer, lung cancer, and thromboembolic disorders. Might not the risk benefit ratio of lower dose, transdermal HRT be favorable?

The use of HRT is attributed not only to breast cancer. The risk of non-small cell lung cancer was cited as a possible complication of HRT. But the "absolute" magnitude of risk was very small and was not close to being significant in the case of never smokers.

Oestrogen plus progestin and lung cancer in postmenopausal women (Women's Health Initiative trial): a post-hoc analysis of a randomised controlled trial

Journal of Midwifery & Women's Health Volume 374, Issue 9697, Pages 1243-1251 (10 October 2009)

Background

In the post-intervention period of the Women's Health Initiative (WHI) trial, women assigned to treatment with oestrogen plus progestin had a higher risk of cancer than did those assigned to placebo. Results also suggested that the combined hormone therapy might increase mortality from lung cancer. To assess whether such an association exists, we undertook a post-hoc analysis of lung cancers diagnosed in the trial over the entire follow-up period.

Methods

The WHI study was a randomised, double-blind, placebo-controlled trial undertaken in 40 centres in the USA. 16608 postmenopausal women aged 50–79 years with an intact uterus were randomly assigned by a computerised, stratified, permuted block algorithm to receive a once-daily tablet of 0·625 mg conjugated equine oestrogen plus 2·5 mg medroxyprogesterone acetate (n=8506) or matching placebo (n=8102). We assessed incidence and mortality rates for all lung cancer, small-cell lung cancer, and non-small-cell lung cancer by use of data from treatment and post-intervention follow-up periods. Analysis was by intention to treat.

Findings

After a mean of 5·6 years (SD 1·3) of treatment and 2·4 years (0·4) of additional follow-up, 109 women in the combined hormone therapy group had been diagnosed with lung cancer compared with 85 in the placebo group (incidence per year 0·16% vs 0·13%; hazard ratio [HR] 1·23, 95% CI 0·92–1·63, p=0·16). 96 women assigned to combined therapy had non-small-cell lung cancer compared with 72 assigned to placebo (0·14% vs 0·11%; HR 1·28, 0·94–1·73, p=0·12). More women died from lung cancer in the combined hormone therapy group than in the placebo group (73 vs 40 deaths; 0·11% vs 0·06%; HR 1·71, 1·16–2·52, p=0·01), mainly as a result of a higher number of deaths from non-small-cell lung cancer in the combined therapy group (62 vs 31 deaths; 0·09% vs 0·05%; HR 1·87, 1·22–2·88, p=0·004). Incidence and mortality rates of small-cell lung cancer were similar between groups.

Interpretation

Although treatment with oestrogen plus progestin in postmenopausal women did not increase incidence of lung cancer, it increased the number of deaths from lung cancer, in particular deaths from non-small-cell lung cancer. These findings should be incorporated into risk–benefit discussions with women considering combined hormone therapy, especially those with a high risk of lung cancer.

Funding

National Heart, Lung and Blood Institute, National Institutes of Health.

10-20-2010, 06:16 PM	#4
gdpawel Senior Member Join Date: Aug 2006 Location: Pennsylvania Posts: 1,080	Risk of NSCLC cited as possible complication of HRT It is being said by some, what is being (erroneously) disseminated in the media is the following message: “Not only does prolonged use of hormone replacement therapy raise the risk of breast cancer, new research finds, but it also ups the risk for more severe forms of the disease and increases a woman’s chances of dying.” This most recent Women's Health Initiative paper only looks at (1) breast cancer mortality and (2) all cause mortality after a diagnosis of breast cancer. It does not report all cause mortality. Therefore, it cannot be stated that HRT “increases a woman’s chances of dying.” Risks and benefits must be individualized. Thin post menopausal women, with physically active lifestyles, non-hyperdense breasts, low to negligible alcohol consumption, lack of family history, negative mammograms, low fat diets, no tobacco use, low risk of coronary artery disease, and severe osteopenia are at high risk for high lethality hip fractures, but at low risk for breast cancer, lung cancer, and thromboembolic disorders. Might not the risk benefit ratio of lower dose, transdermal HRT be favorable? The use of HRT is attributed not only to breast cancer. The risk of non-small cell lung cancer was cited as a possible complication of HRT. But the "absolute" magnitude of risk was very small and was not close to being significant in the case of never smokers. Oestrogen plus progestin and lung cancer in postmenopausal women (Women's Health Initiative trial): a post-hoc analysis of a randomised controlled trial Journal of Midwifery & Women's Health Volume 374, Issue 9697, Pages 1243-1251 (10 October 2009) Background In the post-intervention period of the Women's Health Initiative (WHI) trial, women assigned to treatment with oestrogen plus progestin had a higher risk of cancer than did those assigned to placebo. Results also suggested that the combined hormone therapy might increase mortality from lung cancer. To assess whether such an association exists, we undertook a post-hoc analysis of lung cancers diagnosed in the trial over the entire follow-up period. Methods The WHI study was a randomised, double-blind, placebo-controlled trial undertaken in 40 centres in the USA. 16608 postmenopausal women aged 50–79 years with an intact uterus were randomly assigned by a computerised, stratified, permuted block algorithm to receive a once-daily tablet of 0·625 mg conjugated equine oestrogen plus 2·5 mg medroxyprogesterone acetate (n=8506) or matching placebo (n=8102). We assessed incidence and mortality rates for all lung cancer, small-cell lung cancer, and non-small-cell lung cancer by use of data from treatment and post-intervention follow-up periods. Analysis was by intention to treat. Findings After a mean of 5·6 years (SD 1·3) of treatment and 2·4 years (0·4) of additional follow-up, 109 women in the combined hormone therapy group had been diagnosed with lung cancer compared with 85 in the placebo group (incidence per year 0·16% vs 0·13%; hazard ratio [HR] 1·23, 95% CI 0·92–1·63, p=0·16). 96 women assigned to combined therapy had non-small-cell lung cancer compared with 72 assigned to placebo (0·14% vs 0·11%; HR 1·28, 0·94–1·73, p=0·12). More women died from lung cancer in the combined hormone therapy group than in the placebo group (73 vs 40 deaths; 0·11% vs 0·06%; HR 1·71, 1·16–2·52, p=0·01), mainly as a result of a higher number of deaths from non-small-cell lung cancer in the combined therapy group (62 vs 31 deaths; 0·09% vs 0·05%; HR 1·87, 1·22–2·88, p=0·004). Incidence and mortality rates of small-cell lung cancer were similar between groups. Interpretation Although treatment with oestrogen plus progestin in postmenopausal women did not increase incidence of lung cancer, it increased the number of deaths from lung cancer, in particular deaths from non-small-cell lung cancer. These findings should be incorporated into risk–benefit discussions with women considering combined hormone therapy, especially those with a high risk of lung cancer. Funding National Heart, Lung and Blood Institute, National Institutes of Health.