Menopausal hormone use and ovarian cancer risk: individual participant meta-analysis of 52 epidemiological studies

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Title: Menopausal hormone use and ovarian cancer risk: individual participant meta-analysis of 52 epidemiological studies
Authors: Gapstur, SM
Patel, AV
Banks, E
Dal Maso, L
Talamini, R
Chetrit, A
Hirsh-Yechezkel, G
Lubin, F
Sadetzki, S
Beral, V
Bull, D
Cairns, B
Crossley, B
Gaitskell, K
Goodill, A
Green, J
Hermon, C
Key, T
Moser, K
Reeves, G
Sitas, F
Collins, R
Peto, R
Gonzalez, CA
Lee, N
Marchbanks, P
Ory, HW
Peterson, HB
Wingo, PA
Martin, N
Silpisornkosol, S
Theetranont, C
Boosiri, B
Chutivongse, S
Jimakorn, P
Virutamasen, P
Wongsrichanalai, C
Goodman, MT
Lidegaard, O
Kjaer, SK
Morch, LS
Kjaer, SK
Tjonneland, A
Byers, T
Rohan, T
Mosgaard, B
Vessey, M
Yeates, D
Freudenheim, JL
Titus, LJ
Chang-Claude, J
Kaaks, R
Anderson, KE
Lazovich, D
Robien, K
Hampton, J
Newcomb, PA
Rossing, MA
Thomas, DB
Weiss, NS
Lokkegaard, E
Riboli, E
Clavel-Chapelon, F
Cramer, D
Hankinson, SE
Tamimi, RM
Tworoger, SS
Franceschi, S
La Vecchia, C
Negri, E
Adami, HO
Magnusson, C
Riman, T
Weiderpass, E
Wolk, A
Schouten, LJ
Van den Brandt, PA
Chantarakul, N
Koetsawang, S
Rachawat, D
Palli, D
Black, A
Brinton, LA
Freedman, DM
Hartge, P
Hsing, AW
Jnr, JVL
Lissowska, J
Hoover, RN
Schairer, C
Babb, C
Urban, M
Graff-Iversen, S
Selmer, R
Bain, CJ
Green, AC
Purdie, DM
Siskind, V
Webb, PM
Moysich, K
McCann, SE
Hannaford, P
Kay, C
Binns, CW
Lee, AH
Zhang, M
Ness, RB
Nasca, P
Coogan, PF
Palmer, JR
Rosenberg, L
Whittemore, A
Katsouyanni, K
Trichopoulou, A
Trichopoulos, D
Tzonou, A
Dabancens, A
Martinez, L
Molina, R
Salas, O
Lurie, G
Carney, ME
Wilkens, LR
Hartman, L
Manjer, J
Olsson, H
Kumle, M
Grisso, JA
Morgan, M
Wheeler, JE
Edwards, RP
Kelley, JL
Modugno, F
Onland-Moret, NC
Peeters, PHM
Casagrande, J
Pike, MC
Wu, AH
Canfell, K
Miller, AB
Gram, IT
Lund, E
McGowan, L
Shu, XO
Zheng, W
Farley, TMM
Holck, S
Meirik, O
Risch, HA
Item Type: Journal Article
Abstract: Background Half the epidemiological studies with information about menopausal hormone therapy and ovarian cancer risk remain unpublished, and some retrospective studies could have been biased by selective participation or recall. We aimed to assess with minimal bias the effects of hormone therapy on ovarian cancer risk. Methods Individual participant datasets from 52 epidemiological studies were analysed centrally. The principal analyses involved the prospective studies (with last hormone therapy use extrapolated forwards for up to 4 years). Sensitivity analyses included the retrospective studies. Adjusted Poisson regressions yielded relative risks (RRs) versus never-use. Findings During prospective follow-up, 12 110 postmenopausal women, 55% (6601) of whom had used hormone therapy, developed ovarian cancer. Among women last recorded as current users, risk was increased even with <5 years of use (RR 1·43, 95% CI 1·31–1·56; p<0·0001). Combining current-or-recent use (any duration, but stopped <5 years before diagnosis) resulted in an RR of 1·37 (95% CI 1·29–1·46; p<0·0001); this risk was similar in European and American prospective studies and for oestrogen-only and oestrogen-progestagen preparations, but differed across the four main tumour types (heterogeneity p<0·0001), being definitely increased only for the two most common types, serous (RR 1·53, 95% CI 1·40–1·66; p<0·0001) and endometrioid (1·42, 1·20–1·67; p<0·0001). Risk declined the longer ago use had ceased, although about 10 years after stopping long-duration hormone therapy use there was still an excess of serous or endometrioid tumours (RR 1·25, 95% CI 1·07–1·46, p=0·005). Interpretation The increased risk may well be largely or wholly causal; if it is, women who use hormone therapy for 5 years from around age 50 years have about one extra ovarian cancer per 1000 users and, if its prognosis is typical, about one extra ovarian cancer death per 1700 users.
Issue Date: 13-Feb-2015
Date of Acceptance: 1-Feb-2015
ISSN: 1474-547X
Publisher: Elsevier
Start Page: 1835
End Page: 1842
Journal / Book Title: Lancet
Volume: 385
Issue: 9980
Copyright Statement: © 2015 Collaborative Group on Epidemiological Studies of Ovarian Cancer. Open Access article distributed under the terms of CC BY ( Published by Elsevier Ltd.
Keywords: Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
General & Internal Medicine
11 Medical And Health Sciences
Publication Status: Published
Open Access location:
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care

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