Estrogen, Sequential HRT Raise Ovarian Cancer Risk
Continuous Estrogen/Progestin Does Not Increase Risk
By Laurie Barclay, MD
WebMD Medical News
Reviewed by Gary D. Vogin, MD
April 1, 2002 -- Estrogen replacement or sequential estrogen/progestin therapy raised the risk for epithelial ovarian cancer in a case-control study reported in the April 3 issue of the Journal of the National Cancer Institute. However, the use of continuous estrogen/progestin did not increase ovarian cancer risk.
"If our findings are replicated it would be valuable to consider the epithelial ovarian cancer risk increase associated with the use of certain hormone replacement therapy (HRT) regimens, especially given the prevalence of HRT use and the poor prognosis of epithelial ovarian cancer," write Tomas Riman, MD, from Falu Hospital and Karolinska Institute in Sweden, and colleagues.
This study compared questionnaires about history of HRT use and other potential risk factors in 655 women with epithelial ovarian cancer from Swedish cancer registries, aged 50 to 74, and in 3,899 cancer-free women.
Women who had not had hysterectomy and who had used estrogens alone had a 43% increased risk of developing epithelial ovarian cancer compared with women who had never used such therapy. However, estrogens did not increase risk in women who had undergone hysterectomy.
Women who had used estrogens combined with sequential progestins had a 54% increased risk of developing epithelial ovarian cancer compared with women who had never used this type of therapy. Women who had used estrogens combined with continuous progestins did not appear to have an increased risk of ovarian cancer.
Although women who had used either estrogen-only or sequential HRT for more than 10 years had the greatest increase in risk, the authors caution that the increase in risk is relatively modest and do not recommend changing prescribing practices based on their data. In Sweden, one of 100 women between the ages of 50 and 75 will develop ovarian cancer regardless of HRT use, whereas use of estrogen-only or sequential HRT could cause ovarian cancer in only two or three of 1,000 women.
"For women to make an informed decision about whether or not to use HRT, all beneficial and adverse hormonal aspects concerning [breast cancer,] osteoporosis, coronary heart disease, venous thrombosis, and other health effects must be addressed," they write.
<EM>JAMA.</EM> 2002;286(6):1284-1289
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