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

Gapstur, S. M.; Patel, A. V.; Banks, E.; Dal Maso, L.; Talamini, R.; Chetrit, A.; Hirsh-Yechezkel, G.; Lubin, F.; Sadetzki, S. and Beral, V., et al. (2015) In The Lancet 385(9980). p.1835-1842
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Half the epidemiological studies with information about menopausal hormone therapy and ovarian cancer risk remain unpublished, and some retrospective studies could have been biased by selective participation or recall.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,... (More)
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Half the epidemiological studies with information about menopausal hormone therapy and ovarian cancer risk remain unpublished, and some retrospective studies could have been biased by selective participation or recall.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. (Less)
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The Lancet
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385
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9980
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1835 - 1842
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Elsevier Limited
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  • wos:000354184500027
  • scopus:84929515264
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1474-547X
DOI
10.1016/S0140-6736(14)61687-1
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English
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@article{0f8db601-1edb-451d-a8af-01983fa6f808,
  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 &lt;5 years of use (RR 1.43, 95% CI 1.31-1.56; p&lt;0.0001). Combining current-or-recent use (any duration, but stopped &lt;5 years before diagnosis) resulted in an RR of 1.37 (95% CI 1.29-1.46; p&lt;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&lt;0.0001), being definitely increased only for the two most common types, serous (RR 1.53, 95% CI 1.40-1.66; p&lt;0.0001) and endometrioid (1.42, 1.20-1.67; p&lt;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.},
  author       = {Gapstur, S. M. and Patel, A. V. and Banks, E. and Dal Maso, L. and Talamini, R. and Chetrit, A. and Hirsh-Yechezkel, G. and Lubin, F. and Sadetzki, S. and Beral, V. and Bull, D. and Cairns, B. and Crossley, B. and Gaitskell, K. and Goodill, A. and Green, J. and Hermon, C. and Key, T. and Moser, K. and Reeves, G. and Sitas, F. and Collins, R. and Peto, R. and Gonzalez, C. A. and Lee, N. and Marchbanks, P. and Ory, H. W. and Peterson, H. B. and Wingo, P. A. and Martin, N. and Silpisornkosol, S. and Theetranont, C. and Boosiri, B. and Chutivongse, S. and Jimakorn, P. and Virutamasen, P. and Wongsrichanalai, C. and Goodman, M. T. and Lidegaard, O. and Kjaer, S. K. and Morch, L. S. and Kjaer, S. K. and Tjonneland, A. and Byers, T. and Rohan, T. and Mosgaard, B. and Vessey, M. and Yeates, D. and Freudenheim, J. L. and Titus, L. J. and Chang-Claude, J. and Kaaks, R. and Anderson, K. E. and Lazovich, D. and Robien, K. and Hampton, J. and Newcomb, P. A. and Rossing, M. A. and Thomas, D. B. and Weiss, N. S. and Lokkegaard, E. and Riboli, E. and Clavel-Chapelon, F. and Cramer, D. and Hankinson, S. E. and Tamimi, R. M. and Tworoger, S. S. and Franceschi, S. and La Vecchia, C. and Negri, E. and Adami, H. O. and Magnusson, C. and Riman, T. and Weiderpass, E. and Wolk, A. and Schouten, L. J. and van den Brandt, P. A. and Chantarakul, N. and Koetsawang, S. and Rachawat, D. and Palli, D. and Black, A. and Brinton, L. A. and Freedman, D. M. and Hartge, P. and Hsing, A. W. and Jnr, J. V. Lacey and Lissowska, J. and Hoover, R. N. and Schairer, C. and Babb, C. and Urban, M. and Graff-Iversen, S. and Selmer, R. and Bain, C. J. and Green, A. C. and Purdie, D. M. and Siskind, V. and Webb, P. M. and Moysich, K. and McCann, S. E. and Hannaford, P. and Kay, C. and Binns, C. W. and Lee, A. H. and Zhang, M. and Ness, R. B. and Nasca, P. and Coogan, P. F. and Palmer, J. R. and Rosenberg, L. and Whittemore, A. and Katsouyanni, K. and Trichopoulou, A. and Trichopoulos, D. and Tzonou, A. and Dabancens, A. and Martinez, L. and Molina, R. and Salas, O. and Lurie, G. and Carney, M. E. and Wilkens, L. R. and Werner Hartman, Linda and Manjer, Jonas and Olsson, Håkan and Kumle, M. and Grisso, J. A. and Morgan, M. and Wheeler, J. E. and Edwards, R. P. and Kelley, J. L. and Modugno, F. and Onland-Moret, N. C. and Peeters, P. H. M. and Casagrande, J. and Pike, M. C. and Wu, A. H. and Canfell, K. and Miller, A. B. and Gram, I. T. and Lund, E. and McGowan, L. and Shu, X. O. and Zheng, W. and Farley, T. M. M. and Holck, S. and Meirik, O. and Risch, H. A.},
  issn         = {1474-547X},
  language     = {eng},
  number       = {9980},
  pages        = {1835--1842},
  publisher    = {Elsevier Limited},
  series       = {The Lancet},
  title        = {Menopausal hormone use and ovarian cancer risk: individual participant meta-analysis of 52 epidemiological studies},
  url          = {http://dx.doi.org/10.1016/S0140-6736(14)61687-1},
  volume       = {385},
  year         = {2015},
}