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

Brieger, Katharine K; Peterson, Siri; Lee, Alice W.; Mukherjee, Bhramar; Alimujiang, Aliya; Anton‐Culver, Hoda; Anglesio, Michael S.; Bandera, Elisa V.; Berchuck, Andrew; Bowtell, David D.L.; Chenevix-Trench, Georgia; Cho, Kathleen R.; Cramer, Daniel W.; deFazio, Anna; Doherty, Jennifer A.; Fortner, Renée T.; Garsed, Dale W.; Gayther, Simon A.; Gentry‐Maharaj, Aleksandra; Goode, Ellen L.; Goodman, Marc T.; Harris, Holly R.; Høgdall, Estrid; Huntsman, David G.; Shen, Hui; Jensen, Allan; Johnatty, Sharon E.; Jordan, Susan J.; Kjær, Susanne K.; Kupryjańczyk, Jolanta; Lambrechts, Diether; McLean, Karen; Menon, Usha; Modugno, Francesmary; Moysich, Kirsten B.; Ness, Roberta B.; Ramus, Susan J.; Richardson, Jean L.; Risch, Harvey A.; Rossing, Mary Anne; Trabert, Britton; Wentzensen, Nicolas; Ziogas, Argyrios; Terry, Kathryn L.; Wu, Anna H.; Hanley, Gillian E.; Pharoah, Paul D.P.; Webb, Penelope M.; Pike, Malcolm C.; Pearce, Celeste Leigh

doi:10.1016/j.ygyno.2020.06.481

Cited by 17 publications

(37 citation statements)

References 37 publications

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“…Several other studies have suggested that menopausal hormone use may be associated with improved ovarian cancer survival [36] , [37] , [38] , [39] , but we found no such association, nor did the NIH-AARP study [40] . We found little or no evidence of an association between ovarian cancer survival and other reproductive or hormonal factors, broadly in keeping with previous reports [37] .…”

Section: Discussioncontrasting

confidence: 97%

Ovarian cancer survival by stage, histotype, and pre-diagnostic lifestyle factors, in the prospective UK Million Women Study

Gaitskell

Hermon

Barnes

et al. 2022

Cancer Epidemiology

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Section: Discussioncontrasting

confidence: 97%

Ovarian cancer survival by stage, histotype, and pre-diagnostic lifestyle factors, in the prospective UK Million Women Study

Gaitskell

Hermon

Barnes

et al. 2022

Cancer Epidemiology

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“…However, among women with a historyAU : IntheDiscusion; Ichangedallinstancesof xxxcancersurvivorstowomenw of breast or ovarian cancer, pre-or post-diagnosis MHT use was associated with improved cancer-specific or overall survival. The findings were further replicated by 2 recent prospective cohort studies [114,115]. One possible explanation for these findings could be that women who used MHT after diagnosis were likely to have used MHT before diagnosis.…”

Section: Breast and Ovarian Cancermentioning

confidence: 58%

“…One possible explanation for these findings could be that women who used MHT after diagnosis were likely to have used MHT before diagnosis. Therefore, despite increased incidence of breast and ovarian cancer with MHT use, MHT users with established breast and ovarian tumors may have better prognosis than nonusers [ 114 , 115 ]. Observational data on MHT and breast cancer mortality were controversial.…”

Section: Discussionmentioning

confidence: 99%

Menopausal hormone therapy and women’s health: An umbrella review

et al. 2021

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Background There remains uncertainty about the impact of menopausal hormone therapy (MHT) on women’s health. A systematic, comprehensive assessment of the effects on multiple outcomes is lacking. We conducted an umbrella review to comprehensively summarize evidence on the benefits and harms of MHT across diverse health outcomes. Methods and findings We searched MEDLINE, EMBASE, and 10 other databases from inception to November 26, 2017, updated on December 17, 2020, to identify systematic reviews or meta-analyses of randomized controlled trials (RCTs) and observational studies investigating effects of MHT, including estrogen-alone therapy (ET) and estrogen plus progestin therapy (EPT), in perimenopausal or postmenopausal women in all countries and settings. All health outcomes in previous systematic reviews were included, including menopausal symptoms, surrogate endpoints, biomarkers, various morbidity outcomes, and mortality. Two investigators independently extracted data and assessed methodological quality of systematic reviews using the updated 16-item AMSTAR 2 instrument. Random-effects robust variance estimation was used to combine effect estimates, and 95% prediction intervals (PIs) were calculated whenever possible. We used the term MHT to encompass ET and EPT, and results are presented for MHT for each outcome, unless otherwise indicated. Sixty systematic reviews were included, involving 102 meta-analyses of RCTs and 38 of observational studies, with 102 unique outcomes. The overall quality of included systematic reviews was moderate to poor. In meta-analyses of RCTs, MHT was beneficial for vasomotor symptoms (frequency: 9 trials, 1,104 women, risk ratio [RR] 0.43, 95% CI 0.33 to 0.57, p < 0.001; severity: 7 trials, 503 women, RR 0.29, 95% CI 0.17 to 0.50, p = 0.002) and all fracture (30 trials, 43,188 women, RR 0.72, 95% CI 0.62 to 0.84, p = 0.002, 95% PI 0.58 to 0.87), as well as vaginal atrophy (intravaginal ET), sexual function, vertebral and nonvertebral fracture, diabetes mellitus, cardiovascular mortality (ET), and colorectal cancer (EPT), but harmful for stroke (17 trials, 37,272 women, RR 1.17, 95% CI 1.05 to 1.29, p = 0.027) and venous thromboembolism (23 trials, 42,292 women, RR 1.60, 95% CI 0.99 to 2.58, p = 0.052, 95% PI 1.03 to 2.99), as well as cardiovascular disease incidence and recurrence, cerebrovascular disease, nonfatal stroke, deep vein thrombosis, gallbladder disease requiring surgery, and lung cancer mortality (EPT). In meta-analyses of observational studies, MHT was associated with decreased risks of cataract, glioma, and esophageal, gastric, and colorectal cancer, but increased risks of pulmonary embolism, cholelithiasis, asthma, meningioma, and thyroid, breast, and ovarian cancer. ET and EPT had opposite effects for endometrial cancer, endometrial hyperplasia, and Alzheimer disease. The major limitations include the inability to address the varying effects of MHT by type, dose, formulation, duration of use, route of administration, and age of initiation and to take into account the quality of individual studies included in the systematic reviews. The study protocol is publicly available on PROSPERO (CRD42017083412). Conclusions MHT has a complex balance of benefits and harms on multiple health outcomes. Some effects differ qualitatively between ET and EPT. The quality of available evidence is only moderate to poor.

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“…Twelve prediagnosis exposures of interest were included in this analysis: lifetime alcohol use, aspirin use, other nonsteroidal antiinflammatory drug (NSAID) use, BMI, environmental smoke exposure (ever having been exposed to smoking in the home or at work as defined by each study), history of pelvic inflammatory disease (PID), polycystic ovarian syndrome (PCOS), endometriosis, MHT use, physical inactivity, smoking status, and talc use. Details on the definitions of the exposures have been described elsewhere (5,(27)(28)(29)(30)(31)(32) and are presented in Supplementary Table S1. Within each OCAC study, the pattern of missingness among these exposures was investigated.…”

Section: Methodsmentioning

confidence: 99%

High Prediagnosis Inflammation-Related Risk Score Associated with Decreased Ovarian Cancer Survival

Brieger

Phung

Mukherjee

et al. 2022

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: There is suggestive evidence that inflammation is related to ovarian cancer survival. However, more research is needed to identify inflammation-related factors that are associated with ovarian cancer survival and to determine their combined effects.Methods: This analysis used pooled data on 8,147 women with invasive epithelial ovarian cancer from the Ovarian Cancer Association Consortium. The prediagnosis inflammation-related exposures of interest included alcohol use; aspirin use; other nonsteroidal anti-inflammatory drug use; body mass index; environmental tobacco smoke exposure; history of pelvic inflammatory disease, polycystic ovarian syndrome, and endometriosis; menopausal hormone therapy use; physical inactivity; smoking status; and talc use. Using Cox proportional hazards models, the relationship between each exposure and survival was assessed in 50% of the data. A weighted inflammation-related risk score (IRRS) was developed, and its association with survival was assessed using Cox proportional hazards models in the remaining 50% of the data.Results: There was a statistically significant trend of increasing risk of death per quartile of the IRRS [HR ¼ 1.09; 95% confidence interval (CI), 1.03-1.14]. Women in the upper quartile of the IRRS had a 31% higher death rate compared with the lowest quartile (95% CI, 1.11-1.54).Conclusions: A higher prediagnosis IRRS was associated with an increased mortality risk after an ovarian cancer diagnosis. Further investigation is warranted to evaluate whether postdiagnosis exposures are also associated with survival.Impact: Given that pre-and postdiagnosis exposures are often correlated and many are modifiable, our study results can ultimately motivate the development of behavioral recommendations to enhance survival among patients with ovarian cancer.

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

Cited by 17 publications

References 37 publications

Ovarian cancer survival by stage, histotype, and pre-diagnostic lifestyle factors, in the prospective UK Million Women Study

Ovarian cancer survival by stage, histotype, and pre-diagnostic lifestyle factors, in the prospective UK Million Women Study

Menopausal hormone therapy and women’s health: An umbrella review

High Prediagnosis Inflammation-Related Risk Score Associated with Decreased Ovarian Cancer Survival

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