Hormone replacement therapy increases the risk of cranial meningioma

Andersen, Lene; Friis, Søren; Hallas, Jesper; Ravn, Pernille; Garcı́a-Dorado, David

doi:10.1016/j.ejca.2013.05.026

Cited by 36 publications

(31 citation statements)

References 30 publications

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“…Eight published studies fulfilled the eligibility criteria for this meta-analysis, [3][4][5][6][7][8][9][10]13 and details of these eight studies are shown in Table 4. Two publications by Andersen et al 7,8 are included as one study because the data came from the same source, the Danish National Registries, at the same time.…”

Section: Systematic Review and Meta-analysismentioning

confidence: 99%

“…Two publications by Andersen et al 7,8 are included as one study because the data came from the same source, the Danish National Registries, at the same time. A study by Cea-Soriano et al 19 which included 745 cases of meningioma was not eligible because it used data from the THIN UK primary care database, which overlaps with the GPRD.…”

Section: Systematic Review and Meta-analysismentioning

confidence: 99%

“…[3][4][5][6][7][8][9][10][11][12][13] Evidence is limited by the lack of systematic reporting of findings for all CNS tumors combined, as well as by different tumor subtypes and by specific HT preparations. The findings for all CNS tumors combined are of public health relevance.…”

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confidence: 99%

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Menopausal hormone therapy and central nervous system tumor risk: Large UK prospective study and meta‐analysis

Benson

Kirichek

Beral³

et al. 2014

Intl Journal of Cancer

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Female sex hormones are thought to affect women's risk of developing central nervous system (CNS) tumors. Some have reported an increased risk in users of menopausal hormone therapy (HT) but evidence is limited. In the UK General Practice Research Database we compared prospectively collected information on HT prescriptions in women aged 50-79 years with CNS tumors diagnosed in 1987-2011 with that in matched controls (four per case). Relative risks (RRs) in relation to prescribed HT were calculated overall and by CNS tumor subtype. Statistical tests are two-sided. For all CNS tumors (n 5 3,500), glioma (n 5 689), meningioma (n 5 1,197), acoustic neuroma (n 5 439), and pituitary tumors (n 5 273) adjusted RRs for women prescribed HT versus not were, respectively, 1.21 (95% confidence intervals (CI) 5 1.10-1.32, p < 0.0001), 1.14 (0.93-1.40, p 5 0.2), 1.30 (1.11-1.51, p 5 0.001), 1.37 (1.06-1.75, p 5 0.01), and 1.35 (0.99-1.85, p 5 0.06). There was no significant difference in risk by tumor subtype (p heterogeneity 5 0.6). A meta-analysis was conducted, combining our results with those from other published studies with prospectively collected exposure information. The meta-analyses yielded significantly increased risks for all CNS tumors, glioma and meningioma in users of estrogen-only [1.35 (1.22-1.49), 1.23 (1.06-1.42) and 1.31 (1.20-1.43), respectively] but not estrogen-progestin HT [1.09 (0.99-1.19), 0.92 (0.78-1.08) and 1.05 (0.95-1.16), respectively]; these differences were statistically significant (p < 0.005 for each tumor type). There was no significant difference between glioma and meningioma risk in users of estrogen-only HT. The totality of the available evidence suggests an increased risk of all CNS tumors (and of glioma and meningioma separately) in users of estrogen-only HT. Absolute excess risk (2 per 10,000 users over 5 years) is small.Use of some types of hormone therapy (HT) for the menopause has been associated with an increased risk of cancers of the breast, ovary, and endometrium and decreased risk of cancers of the gastrointestinal tract.1,2 Some, but not all, have reported an increase in the risk of certain central nervous system (CNS) tumors in HT users. [3][4][5][6][7][8][9][10][11][12][13] Evidence is limited by the lack of systematic reporting of findings for all CNS tumors combined, as well as by different tumor subtypes and by specific HT preparations. The findings for all CNS tumors combined are of public health relevance. Reliable assessment of the association between HT use and CNS tumors requires careful control of potential sources of appreciable bias, such as from selective participation or recall of HT use within studies. Differential reporting of HT use in studies where information was recorded retrospectively, i.e., after women had been diagnosed with CNS tumors, is an important source of such bias.To study the association between use of different types of HT and the risk of CNS tumors we used prospectively recorded prescribing information for HT in a case-control study nested ...

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Section: Systematic Review and Meta-analysismentioning

confidence: 99%

Section: Systematic Review and Meta-analysismentioning

confidence: 99%

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Menopausal hormone therapy and central nervous system tumor risk: Large UK prospective study and meta‐analysis

Benson

Kirichek

Beral³

et al. 2014

Intl Journal of Cancer

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“…Only two meta-analyses presented separate results for oestrogen-only and oestrogen-progestogen therapies, showing similar and largest risk reductions (20-30%) in colorectal cancer risk among women currently using oestrogenonly or oestrogen-progestogen therapy [79,80]. Experimental, clinical, and epidemiological studies have suggested that HRT may increase the risk of meningioma [82][83][84][85][86], but decrease the risk of cancers in the upper gastrointestinal tract or lung [80,[87][88][89]. The results for lung cancer may be influenced by negative confounding by smoking, and updates of the WHI Study did not support a protective effect of either oestrogen-only or oestrogen-progestogen therapy against lung cancer [90,91].…”

Section: Other Cancersmentioning

confidence: 92%

European Code against Cancer 4th Edition: Medical exposures, including hormone therapy, and cancer

Friis

Kesminiene

Espina

et al. 2015

Cancer Epidemiology

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The 4th edition of the European Code against Cancer recommends limiting - or avoiding when possible - the use of hormone replacement therapy (HRT) because of the increased risk of cancer, nevertheless acknowledging that prescription of HRT may be indicated under certain medical conditions. Current evidence shows that HRT, generally prescribed as menopausal hormone therapy, is associated with an increased risk of cancers of the breast, endometrium, and ovary, with the risk pattern depending on factors such as the type of therapy (oestrogen-only or combined oestrogen-progestogen), duration of treatment, and initiation according to the time of menopause. Carcinogenicity has also been established for anti-neoplastic agents used in cancer therapy, immunosuppressants, oestrogen-progestogen contraceptives, and tamoxifen. Medical use of ionising radiation, an established carcinogen, can provide major health benefits; however, prudent practices need to be in place, with procedures and techniques providing the needed diagnostic information or therapeutic gain with the lowest possible radiation exposure. For pharmaceutical drugs and medical radiation exposure with convincing evidence on their carcinogenicity, health benefits have to be balanced against the risks; potential increases in long-term cancer risk should be considered in the context of the often substantial and immediate health benefits from diagnosis and/or treatment. Thus, apart from HRT, no general recommendations on reducing cancer risk were given for carcinogenic drugs and medical radiation in the 4th edition of European Code against Cancer. It is crucial that the application of these measures relies on medical expertise and thorough benefit-risk evaluation. This also pertains to cancer-preventive drugs, and self-medication with aspirin or other potential chemopreventive drugs is strongly discouraged because of the possibility of serious, potentially lethal, adverse events.

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“…Additionally, we feel that the relatively high proportion of Grade II/III tumors may reflect a referral bias to our institution. Because past therapeutic radiation [12], BMI in females [13] and hormone replacement therapy [14] have been associated with the development of meningioma, we felt that assessing the association of these factors with the meningioma grade may be important. It should be noted that obesity is associated with higher adipose aromatase activity, estrogen, androgens, and insulin-like growth factor [15].…”

Section: Discussionmentioning

confidence: 99%