Endometrial cancer and patterns of use of oestrogen replacement therapy; A cohort study

Paganini‐Hill, Annlia; Ross, R. K.; Be, Henderson

doi:10.1016/0378-5122(89)90245-4

Cited by 15 publications

(17 citation statements)

References 15 publications

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“…In all categories of surgical history, the endometrioid/clear cell group of tumours retained their elevated risk relative to other tumour types. In addition, among women with an intact genital tract, there was also a noticeable decrease in risk with increasing time since last use of unopposed oestrogen, consistent with the type of association with endometrial carcinomas found by some (Green et al, 1996), though not all studies (Paganini-Hill et al, 1989).…”

Section: Discussionsupporting

confidence: 60%

Hormone replacement therapy and risk of epithelial ovarian cancer

et al. 1999

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It has been suggested that oestrogen replacement therapy is associated with risk of epithelial ovarian cancer of the endometrioid type. Using data from an Australian population-based case–control study, the relation between unopposed oestrogen replacement therapy and epithelial ovarian cancer, both overall and according to histological type, was examined. A total of 793 eligible incident cases of epithelial ovarian cancer diagnosed from 1990 to 1993 among women living in Queensland, New South Wales and Victoria were identified. These were compared with 855 eligible female controls selected at random from the electoral roll, stratified by age and geographic region. Trained interviewers administered standard questionnaires to obtain detailed reproductive and contraceptive histories, as well as details about hormone replacement therapy and pelvic operations. No clear associations were observed between use of hormone replacement therapy overall and risk of ovarian cancer. Unopposed oestrogen replacement therapy was, however, associated with a significant increase in risk of endometrioid or clear cell epithelial ovarian tumours (odds ratio (OR) 2.56; 95% confidence interval (CI) 1.32–4.94). In addition, the risk associated with oestrogen replacement therapy was much larger in women with an intact genital tract (OR 3.00; 95% Cl 1.54–5.85) than in those with a history of either hysterectomy or tubal ligation. Post-menopausal oestrogen replacement therapy may, therefore, be a risk factor associated with endometrioid and clear cell tumours in particular. Additionally, the risk may be increased predominantly in women with an intact genital tract. These associations could reflect a possible role of endometriosis in the development of endometrioid or clear cell ovarian tumours. © 1999 Cancer Research Campaign

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Section: Discussionsupporting

confidence: 60%

Hormone replacement therapy and risk of epithelial ovarian cancer

et al. 1999

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“…Early epidemiologic studies that included low exposure frequencies (22) or preceded widespread combination therapy use in the United States (23)(24)(25) reported null associations between endometrial cancer and combination therapy use. Most subsequent studies found increased risks among women taking sequential estrogen plus progestin (5)(6)(7)(8)26).…”

Section: Discussionmentioning

confidence: 99%

Endometrial Carcinoma Risks among Menopausal Estrogen plus Progestin and Unopposed Estrogen Users in a Cohort of Postmenopausal Women

Lacey

Brinton

Lubin

et al. 2005

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Because unopposed estrogen substantially increases endometrial carcinoma risk, estrogen plus progestin is one menopausal hormone therapy formulation for women who have not had a hysterectomy. However, endometrial carcinoma risks among estrogen plus progestin users and among former unopposed estrogen users are not firmly established. Methods: We evaluated endometrial carcinoma risks associated with estrogen plus progestin and unopposed estrogen therapies in 30,379 postmenopausal Breast Cancer Detection Demonstration Project follow-up study participants. We ascertained hormone therapy use and other risk factors during telephone interviews and mailed questionnaires between 1979 and 1998. We identified 541 endometrial carcinomas via self-report, medical records, the National Death Index, and state cancer registries. Poisson regression generated time-dependent rate ratios (RR) and 95% confidence intervals (95% CI).

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“…The increased risk of endometrial cancer among women who received hormone replacement therapy is in accordance with other previously conducted studies. 15,16 In Denmark most young women who receive hormone replacement therapy are prescribed an estrogen-plus-progestogen regimen, whereas <2% use estrogen-only products. Although we had no information about the specific types of hormone replacement therapy used by the case patients and control subjects, this study suggests that combination regimens do not ensure an unchanged risk of endometrial cancer with respect to women who have never taken hormones.…”

Section: Commentmentioning

confidence: 99%

Risk factors among young women with endometrial cancer: A Danish case-control study

Parslov

Lidegaard

Klintorp

et al. 2000

American Journal of Obstetrics and Gynecology

122

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OBJECTIVE:This study was undertaken to identify and quantify risk factors for endometrial cancer among young women. STUDY DESIGN: This case-control study included all Danish women <50 years old who had endometrial cancer diagnosed during the period 1987 to 1994. A total of 237 case patients and 538 population control subjects matched with the case patients for age and residence were included in the analysis. RESULTS: Women with a family history of endometrial cancer had an odds ratio for endometrial cancer of 2.1 (95% confidence interval, 1.1-3.8)). Completion of 1 term pregnancy implied an odds ratio of 0.6 (95% confidence interval, 0.3-1.1). The risk of endometrial cancer decreased significantly with increasing age at first birth and with the number of induced abortions. Use of oral contraceptives for 1 to 5 years decreased the risk of endometrial cancer (odds ratio, 0.2; 95% confidence interval, 0.1-0.3). The odds ratio for endometrial cancer among women who received hormone replacement therapy for 1 to 5 years was 3.1 (95% confidence interval, 1.4-7.0). Body mass index was not demonstrated to be an independent risk factor in this study. The protective impacts of the different exposures (risk factors) can be expressed as etiologic fractions, which indicate how much each exposure reduces the occurrence of endometrial cancer compared with a situation without the existence of that particular exposure. These fractions were as follows: oral contraceptive use for ≥1 year, -45%; 2 term pregnancies, -88%; age ≥30 y when giving birth for the first time, -38%; and a history of incomplete pregnancy, -16%. Key words: Case-control study, endometrial cancer, etiologic fraction, premenopausal, risk factor Endometrial cancer is a rare disease among premenopausal women. Seven percent of endometrial cancer occurs in women <50 years old. In the same age group about 300 curettage procedures and an equal number of endometrial biopsies are performed for every single diagnosis of endometrial cancer. When the physical complications attendant with these invasive procedures and the socioeconomic consequences of curettage as a screening procedure are considered, the question arises as to whether it is appropriate to carry out this number of intrauterine procedures in fertile women to find so few cases of endometrial malignancy.If young women at an increased risk for development of endometrial cancer could be identified, a selection of women among whom the need to undergo curettage was greater might be realized. Consequently, the number of curettage procedures performed in this age group could be reduced.Several studies have identified risk factors of endometrial cancer among older women, such as overweight status, estrogen replacement therapy, nulliparity, infertility, diabetes mellitus, and hypertension. 1-8 However, these risk factors are not necessarily relevant for endometrial cancer among young women. Only a few studies have focused on risk factors for endometrial cancer among premenopausal women (Table I). To identify and quantif...

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Endometrial cancer and patterns of use of oestrogen replacement therapy; A cohort study

Cited by 15 publications

References 15 publications

Hormone replacement therapy and risk of epithelial ovarian cancer

Hormone replacement therapy and risk of epithelial ovarian cancer

Endometrial Carcinoma Risks among Menopausal Estrogen plus Progestin and Unopposed Estrogen Users in a Cohort of Postmenopausal Women

Risk factors among young women with endometrial cancer: A Danish case-control study

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