Hormone replacement therapy and cancer survival: a longitudinal cohort study: protocol paper

Abstract

IntroductionHormone replacement therapy (HRT) can help women experiencing menopausal symptoms, but usage has declined due to uncertainty around risks of cancer and some cardiovascular diseases (CVD). Moreover, improved cancer survival rates mean that more women who survive cancer go on to experience menopausal symptoms. Understanding these relationships is important so that women and their clinicians can make informed decisions around the risks and benefits of HRT. This study’s primary aim is to determine the association between HRT use after cancer diagnosis and the risk of cancer-specific mortality. The secondary aims are to investigate the risks of HRT on subsequent cancer, all-cause mortality and CVD.Methods and analysisWe will conduct a population-based longitudinal cohort study of 18–79 year-old women diagnosed with cancer between 1998 and 2020, using the QResearch database. The main exposure is HRT use, categorised based on compound, dose and route of administration, and modelled as a time-varying covariate. Analysis of HRT use precancer and postcancer diagnosis will be conducted separately. The primary outcome is cancer-specific mortality, which will be stratified by cancer site. Secondary outcomes include subsequent cancer diagnosis, CVD (including venous thrombo-embolism) and all-cause mortality. Adjustment will be made for key confounders such as age, body mass index, ethnicity, deprivation index, comorbidities, and cancer grade, stage and treatment. Statistical analysis will include descriptive statistics and Cox proportional hazards models to calculate HRs and 95% CIs.Ethics and disseminationEthical approval for this project was obtained from the QResearch Scientific Committee (Ref: OX24, project title ‘Use of hormone replacement therapy and survival from cancer’). This project has been, and will continue to be, supported by patient and public involvement panels. We intend to the submit the findings for peer-reviewed publication in an academic journal and disseminate them to the public through Cancer Research UK.

Prevalence and Risk Factors Associated with Upper Gastrointestinal Malignancies in Post-Menopausal Patients on Hormone Replacement Therapy: A Population-Based Study

“…Currently used hormone replacement therapy consists of estrogen pills for hysterectomized women and estrogen-progestin combinations for the rest [19,20]. Estrogen helps alleviate menopausal symptoms, while progestin prevents estrogen-induced proliferation of uterine epithelium The mechanism by which HRT affects GI tissues is not well understood.…”

“…While some studies showed that estrogen promotes malignancy by stimulating growth of cells like bladder and gastric tissues, others noted that it delays progression of EOC and melanoma [19]. To note, estrogen-progestin combination was associated with a higher risk of breast cancer compared to estrogen-only HRT, raising questions around the role of progestin in the development of cancer [20].…”

Condutas para o manejo dos sintomas climatéricos em pacientes com câncer de mama: revisão de literatura integrativa

“…17 Evidências apontam que o uso de estrogênio pode estimular a proliferação celular maligna em alguns casos, mas retardar em outros. 16 Kohn et al 8 realizaram uma revisão de literatura em que o estrogênio isolado foi utilizado como forma de tratamento para os sintomas climatéricos. Essa terapia apresentou uma melhora nos sintomas sexuais e geniturinários, como ondas de calor, sudorese noturna, rubor e atrofia vulvovaginal e sintomas vasomotores.…”

Impact of vaginal submucosal platelet-rich plasma combined with non-cross-linked hyaluronic acid injections on dyspareunia and sexual satisfaction in a Hodgkin lymphoma cancer survivor: a case report

“…Symptoms of vulvovaginal atrophy or genitourinary syndrome of menopause occur secondary to oestrogen deficiency caused by different cancer therapies (radiotherapy, chemotherapy, and surgery. 1 The genitourinary syndrome of menopause (GSM) is a newer nomenclature for the condition previously known as vulvovaginal atrophy. It is characterized by a constellation of signs and symptoms resulting from diminished oestrogen.…”