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Stute P, Marsden J, Salih N, Cagnacci A. Reappraising 21 years of the WHI study: Putting the findings in context for clinical practice. Maturitas 2023; 174:8-13. [PMID: 37209498 DOI: 10.1016/j.maturitas.2023.04.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/12/2023] [Accepted: 04/30/2023] [Indexed: 05/22/2023]
Abstract
Menopausal hormone treatment (MHT) is recommended for the management of menopause symptoms. The Women's Health Initiative (WHI) placebo-controlled randomised study examined the effects of continuous combined or estrogen-only MHT on the risk of non-communicable diseases (NCDs) in post-menopausal women. The study was terminated prematurely after an interim analysis showed an increased risk of breast cancer diagnosis, which led to a rapid decrease in MHT use worldwide. Subsequently, limitations of the study design and its interpretation in the context of other clinical studies has contributed to a more nuanced appreciation of the risk-benefit profile of differing MHT regimens regarding risk associated with the class of progestogen prescribed, its pattern of prescription, duration of use and timing of initiation related to menopause onset. This review provides a contextual interpretation of the WHI placebo-controlled study and evaluates the impact of bioidentical MHT, with a focus on combined therapies containing micronised progesterone, on the risk of chronic NCDs in post-menopausal women.
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Affiliation(s)
- Petra Stute
- Department of Obstetrics and Gynaecology, University of Bern, Friedbühlstrasse 19, 3010 Bern, Switzerland.
| | - Jo Marsden
- President, The British Association of Day Surgery, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK; Consultant Breast Surgeon (retired); King's College Hospital NHS Foundation Trust, London, UK; British Menopause Society Medical Advisory Council (2003-2009 and 2015-2021), UK
| | - Noor Salih
- Theramex, Sloane Square House, 1 Holbein Place, London SW1W 8NS, UK.
| | - Angelo Cagnacci
- Obstetrics and Gynaecology Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, San Martino Hospital, Genova, Italy; President of the Italian Society for the Menopause; Largo Rosanna Benzi, 10, 16132, Genova, Italy.
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Nakhostin L, Stadler A, Stute P. Impact of menopausal hormone therapy on colorectal cancer risk-A systematic review. Clin Endocrinol (Oxf) 2021; 95:390-397. [PMID: 33752259 DOI: 10.1111/cen.14469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/14/2021] [Accepted: 03/14/2021] [Indexed: 12/01/2022]
Abstract
Colorectal cancer (CRC) is the second most frequently diagnosed cancer in females worldwide. Menopausal hormone therapy (MHT) has been proposed as a potential protective factor for the development of CRC. Yet, the available evidence is controversial. Thus, we aimed at summarizing the current evidence on the effect of MHT on CRC through a systematic review. A systematic literature search identified 1001 potentially relevant articles, out of which 57 original studies and nine meta-analyses were deemed eligible for the final synthesis. The evidence synthesis showed the following: (1) MHT showed a heterogeneity in findings for CRC risk with a slight tendency to a neutral or protective effect; (2) MHT effect was either neutral or protective on colorectal adenoma; (3) MHT had no impact on tumour grade, subsite and histologic types; (4) MHT was not associated with CRC mortality; and (5) MHT showed heterogeneous effects on CRC stage and invasiveness, respectively. In summary, despite some evidence pointing towards a protective effect of MHT on CRC, MHT is currently not recommended for primary CRC prevention by international guidelines due to several important, potentially harmful effects.
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Affiliation(s)
- Livia Nakhostin
- Department of Obstetrics and Gynecology, University Clinic Inselspital Bern, Bern, Switzerland
| | - Aurelia Stadler
- Department of Obstetrics and Gynecology, University Clinic Inselspital Bern, Bern, Switzerland
| | - Petra Stute
- Department of Obstetrics and Gynecology, University Clinic Inselspital Bern, Bern, Switzerland
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Chen B, Zheng D, Yu W, Huang C, Ye J, Han G, Zhuang J. Cetuximab versus bevacizumab maintenance following prior 8-cycle modified FOLFOXIRI plus cetuximab in Asian postmenopausal women with treatment-naive KRAS and BRAF wild-type metastatic colorectal cancer. J Int Med Res 2021; 48:300060520930440. [PMID: 32993393 PMCID: PMC7545770 DOI: 10.1177/0300060520930440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the efficacy and safety of cetuximab (CE) versus bevacizumab (BE) maintenance treatment after prior 8-cycle modified 5-fluorouracil, folinate, oxaliplatin, and irinotecan (FOLFOXIRI) plus CE induction therapy in treatment-naive KRAS and BRAF wild-type (wt) metastatic colorectal cancer (mCRC). METHODS From 2012 to 2017, prospectively maintained databases were reviewed to assess Asian postmenopausal women with treatment-naive KRAS and BRAF wt mCRC who underwent modified FOLFOXIRI plus CE induction therapy, followed by CE or BE maintenance until disease progression or death. Co-primary clinical endpoints were progression-free survival (PFS) and overall survival (OS). RESULTS A total of 222 women were included (CE n = 110 and BE n = 112). At a median follow-up of 27.0 months (interquartile range, 6.5-38.6 months), median PFS was 21.9 months (95% confidence interval [CI] 16.4-24.4) and 17.7 months (95% CI 11.3-19.0) for CE and BE groups, respectively (hazard ratio [HR] 0.31, 95% CI 0.15-0.46); median OS was 26.0 months (95% CI 23.4-28.7) and 22.7 months (95% CI 21.2-24.3) for CE and BE groups, respectively (HR 0.22, 95% CI 0.11-0.37). CONCLUSIONS CE maintenance treatment is more poorly tolerated but has a slightly more modest survival benefit compared with BE maintenance treatment in mCRC.
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Affiliation(s)
- Baomin Chen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Donghua Zheng
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weiguang Yu
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Cuiping Huang
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Junxing Ye
- Department of Orthopaedics, The Third People's Hospital of Wuxi, Jiangsu Province; The Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Guowei Han
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jintao Zhuang
- Department of Urology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Huang C, Gu X, Zeng X, Chen B, Yu W, Chen M. Cetuximab versus bevacizumab following prior FOLFOXIRI and bevacizumab in postmenopausal women with advanced KRAS and BRAF wild-type colorectal cancer: a retrospective study. BMC Cancer 2021; 21:30. [PMID: 33413175 PMCID: PMC7789412 DOI: 10.1186/s12885-020-07770-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/26/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND An upgraded understanding of factors (sex/estrogen) associated with survival benefit in advanced colorectal carcinoma (CRC) could improve personalised management and provide innovative insights into anti-tumour mechanisms. The aim of this study was to assess the efficacy and safety of cetuximab (CET) versus bevacizumab (BEV) following prior 12 cycles of fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) plus BEV in postmenopausal women with advanced KRAS and BRAF wild-type (wt) CRC. METHODS Prospectively maintained databases were reviewed from 2013 to 2017 to assess postmenopausal women with advanced KRAS and BRAF wt CRC who received up to 12 cycles of FOLFOXIRI plus BEV inductive treatment, followed by CET or BEV maintenance treatment. The primary endpoints were overall survival (OS), progression-free survival (PFS), response rate. The secondary endpoint was the rate of adverse events (AEs). RESULTS At a median follow-up of 27.0 months (IQR 25.1-29.2), significant difference was detected in median OS (17.7 months [95% confidence interval [CI], 16.2-18.6] for CET vs. 11.7 months [95% CI, 10.4-12.8] for BEV; hazard ratio [HR], 0.63; 95% CI, 0.44-0.89; p=0.007); Median PFS was 10.7 months (95% CI, 9.8-11.3) for CET vs. 8.4 months (95% CI, 7.2-9.6) for BEV (HR, 0.67; 95% CI 0.47-0.94; p=0.02). Dose reduction due to intolerable AEs occurred in 29 cases (24 [24.0%] for CET vs. 5 [4.8%] for BEV; p< 0.001). CONCLUSIONS CET tends to be superior survival benefit when compared with BEV, with tolerated AEs.
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Affiliation(s)
- Chunlong Huang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080 China
| | - Xiaoyuan Gu
- Department of Oncology, Shibei Hospital of Shanghai, No. 4500, Goughexin Road, Jing’ an District, Shanghai, 200443 China
| | - Xianshang Zeng
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080 China
| | - Baomin Chen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080 China
| | - Weiguang Yu
- Department of Orthopaedics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080 China
| | - Meiji Chen
- Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080 China
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Ortmann O, Emons G, Tempfer C. S3-Leitlinie: Hormonersatztherapie und Krebsrisiko. GYNAKOLOGISCHE ENDOKRINOLOGIE 2020. [DOI: 10.1007/s10304-020-00309-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Botteri E, Støer NC, Sakshaug S, Graff-Iversen S, Vangen S, Hofvind S, de Lange T, Bagnardi V, Ursin G, Weiderpass E. Menopausal hormone therapy and colorectal cancer: a linkage between nationwide registries in Norway. BMJ Open 2017; 7:e017639. [PMID: 29146641 PMCID: PMC5695317 DOI: 10.1136/bmjopen-2017-017639] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES With the present study, we aimed to investigate the association between menopausal hormone therapy (HT) and risk of colorectal cancer (CRC). SETTING Cohort study based on the linkage of Norwegian population-based registries. PARTICIPANTS We selected 466822 Norwegian women, aged 55-79, alive and residing in Norway as of 1 January 2004, and we followed them from 2004 to 2008. Each woman contributed person-years at risk as non-user, current user and/or past HT user. OUTCOME MEASURES The outcome of interest was adenocarcinoma of the colorectal tract, overall, by anatomic site and stage at diagnosis. Incidence rate ratios (RRs) with 95% CIs were estimated by Poisson regression and were used to evaluate the association between HT and CRC incidence. RESULTS During the median follow-up of 4.8 years, 138 655 (30%) women received HT and 3799 (0.8%) incident CRCs occurred. Current, but not past, use of HT was associated with a lower risk of CRC (RR 0.88; 95% CI 0.80 to 0.98). RRs for localised, regionally advanced and metastatic CRC were 1.13 (95% CI 0.91 to 1.41), 0.81 (95% CI 0.70 to 0.94) and 0.79 (95% CI 0.62 to 1.00), respectively. RRs for current use of oestrogen therapy (ET) were 0.91 (95% CI 0.80 to 1.04) while RR for current use of combined oestrogen-progestin therapy (EPT) was 0.85 (95% CI 0.70 to 1.03), as compared with no use of HT. The same figures for ET and EPT in oral formulations were 0.83 (95% CI 0.68 to 1.03) and 0.86 (95% CI 0.71 to 1.05), respectively. CONCLUSIONS In our nationwide cohort study, HT use lowered the risk of CRC, specifically the most advanced CRC.
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Affiliation(s)
- Edoardo Botteri
- Norwegian National Advisory Unit for Women’s Health, Women’s Clinic, Oslo University Hospital, Oslo, Norway
- Department of Bowel Cancer Screening, Cancer Registry of Norway, Oslo University Hospital, Oslo, Norway
| | - Nathalie C Støer
- Norwegian National Advisory Unit for Women’s Health, Women’s Clinic, Oslo University Hospital, Oslo, Norway
| | - Solveig Sakshaug
- Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Sidsel Graff-Iversen
- Department of Non-Communicable Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Siri Vangen
- Norwegian National Advisory Unit for Women’s Health, Women’s Clinic, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Solveig Hofvind
- Faculty of Health Science, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
- Department of Mammography Screening, Cancer Registry of Norway, Oslo University Hospital, Oslo, Norway
| | - Thomas de Lange
- Department of Bowel Cancer Screening, Cancer Registry of Norway, Oslo University Hospital, Oslo, Norway
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Giske Ursin
- Cancer Registry of Norway, Oslo University Hospital, Oslo, Norway
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Department of Preventive Medicine, University of Southern California, Los Angeles, USA
| | - Elisabete Weiderpass
- Department of Research, Cancer Registry of Norway, Oslo University Hospital, Oslo, Norway
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, the Arctic University of Norway, Tromsø, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Genetic Epidemiology, Folkhälsan Research Center, Helsinki, Finland
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Moslehi N, Mirmiran P, Tehrani FR, Azizi F. Current Evidence on Associations of Nutritional Factors with Ovarian Reserve and Timing of Menopause: A Systematic Review. Adv Nutr 2017; 8:597-612. [PMID: 28710146 PMCID: PMC5502869 DOI: 10.3945/an.116.014647] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Ovarian aging is thought to be influenced by environmental factors, including nutrition. The aim of this study was to systematically review current evidence on the associations between nutritional factors, ovarian reserve, and age at menopause. PubMed and Scopus were structurally searched until May 2016. Original studies, with either observational or interventional designs, that examined the associations of nutritional factors (serum or dietary nutrients, food groups, and/or dietary patterns) with different ovarian reserve markers and/or timing of menopause were considered eligible. Twenty-six studies met the inclusion criteria: 17 studies on ovarian reserve markers and 9 studies on menopausal age. Significant diversity was observed in nutritional factors examined across studies. In the study of nutritional factors, associations of serum 25-hydroxyvitamin D [25(OH)D] concentration and intakes of soy or soy products with ovarian reserve have been the most investigated. For associations with menopausal age, intakes of total fat, fiber, and soy products have been mainly examined. Significant associations with ovarian reserve markers were found in 4 of 7 studies on serum 25(OH)D, 2 of 6 studies on soy or soy products, 1 of 2 studies on fiber intake, 1 study on serum zinc and copper concentrations, and 1 study on serum antioxidant concentrations. Studies on nutritional factors and menopausal age provided inconsistent findings, some of which suggested modest associations. Although there is some promising evidence on the influential role of nutrition in ovarian aging, a limited number of studies, heterogeneous in their design and study of nutritional factors, makes it difficult to draw definite conclusions. To better understand this issue, examination of associations of dietary intakes or dietary patterns with more precise markers of ovarian reserve, such as anti-mullerian hormone and antral follicle count, with age at menopause is needed. In addition, to explore whether nutritional factors alter the process of ovarian aging, an examination of changes in ovarian reserve markers should be considered.
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Affiliation(s)
| | - Parvin Mirmiran
- Department of Nutrition and Clinical Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences; and
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8
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Liu D. Gene signatures of estrogen and progesterone receptor pathways predict the prognosis of colorectal cancer. FEBS J 2016; 283:3115-33. [PMID: 27376509 DOI: 10.1111/febs.13798] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 06/21/2016] [Accepted: 06/30/2016] [Indexed: 12/19/2022]
Abstract
The associations of estrogen receptor (ER) and progesterone receptor (PR) pathways with the prognosis of colorectal cancer (CRC) are still controversial. The aim of this study was to readdress these issues by introducing a gene signature-based approach to semiquantitate pathway activity. In this approach, the ER and PR pathway activities in CRC were computed based on the expression profiles of the signature genes of ER and PR pathways, respectively. The results showed that the ER pathway activity was progressively significantly decreased from normal colorectal mucosa, colorectal adenoma to CRC. ER pathway signaling was a favorable factor for the presence of microsatellite stability (MSS) in CRC in seven cohorts tested, while was an unfavorable factor for cancer recurrence in all four CRC cohorts tested (n = 1122; overall HR: 0.311, 95% CI: 0.199-0.488, P < 0.001). Subset stratification in stage II patients showed that ER pathway remained significantly inversely associated with recurrence. PR pathway was also suppressed in colorectal tumors and inversely associated with recurrence of CRC, but to a much lesser extent than ER pathway. Moreover, the inverse association of PR pathway with cancer recurrence was more likely observed in CRC with high ER pathway activity, suggesting the interactions between the two pathways. PR pathway was not associated with MSS in CRC, but it was more significant than ER pathway associated with advance cancer stages and cancer response to adjuvant chemotherapy. These results suggested the potential application of the gene signatures of ER and PR pathways, especially the former, as novel markers for prognosis and management of CRC.
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Affiliation(s)
- Dingxie Liu
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Bluewater Biotech LLC, Berkeley Heights, NJ, USA
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Mørch LS, Lidegaard Ø, Keiding N, Løkkegaard E, Kjær SK. The influence of hormone therapies on colon and rectal cancer. Eur J Epidemiol 2016; 31:481-9. [PMID: 26758900 DOI: 10.1007/s10654-016-0116-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 01/02/2016] [Indexed: 12/25/2022]
Abstract
Exogenous sex hormones seem to play a role in colorectal carcinogenesis. Little is known about the influence of different types or durations of postmenopausal hormone therapy (HT) on colorectal cancer risk. A nationwide cohort of women 50-79 years old without previous cancer (n = 1,006,219) were followed 1995-2009. Information on HT exposures was from the National Prescription Register and updated daily, while information on colon (n = 8377) and rectal cancers (n = 4742) were from the National Cancer Registry. Potential confounders were obtained from other national registers. Poisson regression analyses with 5-year age bands included hormone exposures as time-dependent covariates. Use of estrogen-only therapy and combined therapy were associated with decreased risks of colon cancer (adjusted incidence rate ratio 0.77, 95 % confidence interval 0.68-0.86 and 0.88, 0.80-0.96) and rectal cancer (0.83, 0.72-0.96 and 0.89, 0.80-1.00), compared to never users. Transdermal estrogen-only therapy implied more protection than oral administration, while no significant influence was found of regimen, progestin type, nor of tibolone. The benefit of HT was stronger for long-term hormone users; and hormone users were at lower risk of advanced stage of colorectal cancer, which seems supportive for a causal association between hormone therapy and colorectal cancer.
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Affiliation(s)
- Lina Steinrud Mørch
- Gynecological Clinic, The Juliane Marie Centre, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Centre, Copenhagen, Denmark.
| | - Øjvind Lidegaard
- Gynecological Clinic, The Juliane Marie Centre, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Niels Keiding
- Department of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ellen Løkkegaard
- Gynecological-Obstetrical Department, North Zealand Hospital, University of Copenhagen, Hillerød, Denmark
| | - Susanne Krüger Kjær
- Gynecological Clinic, The Juliane Marie Centre, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Centre, Copenhagen, Denmark
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Lavasani S, Chlebowski RT, Prentice RL, Kato I, Wactawski-Wende J, Johnson KC, Young A, Rodabough R, Hubbell FA, Mahinbakht A, Simon MS. Estrogen and colorectal cancer incidence and mortality. Cancer 2015; 121:3261-71. [DOI: 10.1002/cncr.29464] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 02/26/2015] [Accepted: 04/03/2015] [Indexed: 01/05/2023]
Affiliation(s)
- Sayeh Lavasani
- Karmanos Cancer Institute; Department of Oncology; Wayne State University; Detroit Michigan
- Population Studies and Prevention Program; Karmanos Cancer Institute, Wayne State University; Detroit Michigan
| | - Rowan T. Chlebowski
- Los Angeles Biomedical Research Institute; Harbor-UCLA Medical Center; Torrance California
| | - Ross L. Prentice
- Division of Public Health Sciences; Fred Hutchinson Cancer Research Center; Seattle Washington
| | - Ikuko Kato
- Population Studies and Prevention Program; Karmanos Cancer Institute, Wayne State University; Detroit Michigan
- Department of Pathology; Wayne State University; Detroit Michigan
| | - Jean Wactawski-Wende
- Department of Social and Preventive Medicine; University at Buffalo; Buffalo New York
| | - Karen C. Johnson
- Department of Preventive Medicine; University of Tennessee Health Science Center; Memphis Tennessee
| | - Alicia Young
- Division of Public Health Sciences; Fred Hutchinson Cancer Research Center; Seattle Washington
| | - Rebecca Rodabough
- Division of Public Health Sciences; Fred Hutchinson Cancer Research Center; Seattle Washington
| | - F. Allan Hubbell
- Department of Medicine; University of California Irvine; Irvine California
| | | | - Michael S. Simon
- Karmanos Cancer Institute; Department of Oncology; Wayne State University; Detroit Michigan
- Population Studies and Prevention Program; Karmanos Cancer Institute, Wayne State University; Detroit Michigan
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11
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Clavel-Chapelon F. Cohort Profile: The French E3N Cohort Study. Int J Epidemiol 2014; 44:801-9. [PMID: 25212479 DOI: 10.1093/ije/dyu184] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2014] [Indexed: 11/13/2022] Open
Abstract
The E3N (Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l'Education Nationale) cohort was initiated in 1990 to investigate therisk factors associated with cancer and other major non-communicable diseases in women. The participants were insured through a national health system that primarily covered teachers, and were enrolled from 1990 after returning baseline self-administered questionnaires and providing informed consent. The cohort comprised nearly 100,000 women with baseline ages ranging from 40 to 65 years. Follow-up questionnaires were sent approximately every 2-3 years after the baseline and addressed general and lifestyle characteristics together with medical events (cancer, cardiovascular diseases, diabetes, depression, fractures and asthma, among others). The follow-up questionnaire response rate remained stable at approximately 80%. A biological material bank was generated and included blood samples collected from 25,000 women and saliva samples from an additional 47,000 women. Ageing among the E3N cohort provided the opportunity to investigate factors related to age-related diseases and conditions as well as disease survival. The new E4N complementary cohort (Epidemiology 4 kNowledge), which comprises the children and grandchildren of the E3N cohort as well as the children's fathers, will allow researchers to investigate key life periods during which exposures to environmental factors most strongly influence the later disease risk. The E3N and E4N cohort data will be used to investigate diseases and risk factors through a transgenerational approach. Requests for collaborations are welcome, particularly those in conjunction with rare diseases.
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12
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Brändstedt J, Wangefjord S, Nodin B, Eberhard J, Jirström K, Manjer J. Associations of hormone replacement therapy and oral contraceptives with risk of colorectal cancer defined by clinicopathological factors, beta-catenin alterations, expression of cyclin D1, p53, and microsatellite-instability. BMC Cancer 2014; 14:371. [PMID: 24885829 PMCID: PMC4041054 DOI: 10.1186/1471-2407-14-371] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 05/21/2014] [Indexed: 12/18/2022] Open
Abstract
Background Postmenopausal hormone therapy (HRT) and oral contraceptive (OC) use have in several studies been reported to be associated with a decreased colorectal cancer (CRC) risk. However, data on the association between HRT and OC and risk of different clinicopathological and molecular subsets of CRC are lacking. The aim of this molecular pathological epidemiology study was therefore to evaluate the associations between HRT and OC use and risk of specific CRC subgroups, overall and by tumour site. Method In the population-based prospective cohort study Mamö Diet and Cancer, including 17035 women, 304 cases of CRC were diagnosed up until 31 December 2008. Immunohistochemical expression of beta-catenin, cyclin D1, p53 and MSI-screening status had previously been assessed in tissue microarrays with tumours from 280 cases. HRT was assessed as current use of combined HRT (CHRT) or unopposed oestrogen (ERT), and analysed among 12583 peri-and postmenopausal women. OC use was assessed as ever vs never use among all women in the cohort. A multivariate Cox regression model was applied to determine hazard ratios for risk of CRC, overall and according to molecular subgroups, in relation to HRT and OC use. Results There was no significantly reduced risk of CRC by CHRT or ERT use, however a reduced risk of T-stage 1–2 tumours was seen among CHRT users (HR: 0.24; 95% CI: 0.09-0.77). Analysis stratified by tumour location revealed a reduced overall risk of rectal, but not colon, cancer among CHRT and ERT users, including T stage 1–2, lymph node negative, distant metastasis-free, cyclin D1 - and p53 negative tumours. In unadjusted analysis, OC use was significantly associated with a reduced overall risk of CRC (HR: 0.56; 95% CI: 0.44-0.71), but this significance was not retained in adjusted analysis (HR: 1.05: 95% CI: 0.80-1.37). A similar risk reduction was seen for the majority of clinicopathological and molecular subgroups. Conclusion Our findings provide information on the relationship between use of HRT and OC and risk of clinicopathological and molecular subsets of CRC.
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Affiliation(s)
- Jenny Brändstedt
- Department of Clinical Sciences, Lund, Oncology and Pathology, Lund University, Skåne University Hospital, Lund, Sweden.
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Abstract
Worldwide, colorectal cancer has a higher incidence rate in men than in women, suggesting a protective role for sex hormones in the development of the disease. Preclinical data support a role for estrogen and its receptors in the initiation and progression of colorectal cancer and establishes that protective effects of estrogen are exerted through ERβ. Hormone replacement therapy (HRT) in postmenopausal women as well as consumption of soy reduces the incidence of colorectal cancer. In the Women's Health Initiative trial, use of HRT in postmenopausal women reduced the risk of colon cancer by 56% [95% confidence interval (CI), 0.38-0.81; P = 0.003]. A recent meta-analysis showed that in women, consumption of soy reduced the risk of colon cancer by 21% (95% CI, 0.03-0.35; P = 0.026). In this review, using the preclinical data, we translate the findings in the clinical trials and observational studies to define the role of estrogen in the prevention of colorectal cancer. We hypothesize that sometime during the tumorigenesis process ERβ expression in colonocytes is lost and the estrogen ligand, HRT, or soy products, exerts its effects through preventing this loss. Thus, in the adenoma-to-carcinoma continuum, timing of HRT is a significant determinant of the observed benefit from this intervention. We further argue that the protective effects of estrogen are limited to certain molecular subtypes. Successful development of estrogen modulators for prevention of colorectal cancer depends on identification of susceptible colorectal cancer population(s). Thus, research to better understand the estrogen pathway is fundamental for clinical delivery of these agents.
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Affiliation(s)
- Afsaneh Barzi
- Authors' Affiliations: USC Norris Comprehensive Cancer Center, Los Angeles; and Azusa Pacific University, Azusa, California
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14
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Simon MS, Chlebowski RT, Wactawski-Wende J, Johnson KC, Muskovitz A, Kato I, Young A, Hubbell FA, Prentice RL. Estrogen plus progestin and colorectal cancer incidence and mortality. J Clin Oncol 2012; 30:3983-90. [PMID: 23008295 DOI: 10.1200/jco.2012.42.7732] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE During the intervention phase in the Women's Health Initiative (WHI) clinical trial, use of estrogen plus progestin reduced the colorectal cancer diagnosis rate, but the cancers were found at a substantially higher stage. To assess the clinical relevance of the findings, analyses of the influence of combined hormone therapy on colorectal cancer incidence and colorectal cancer mortality were conducted after extended follow-up. PATIENTS AND METHODS The WHI study was a randomized, double-blind, placebo-controlled clinical trial involving 16,608 postmenopausal women with an intact uterus who were randomly assigned to daily 0.625 mg conjugated equine estrogen plus 2.5 mg medroxyprogesterone acetate (n = 8,506) or matching placebo (n = 8,102). Colorectal cancer diagnosis rates and colorectal cancer mortality were assessed. RESULTS After a mean of 5.6 years (standard deviation [SD], 1.03 years) of intervention and 11.6 years (SD, 3.1 years) of total follow-up, fewer colorectal cancers were diagnosed in the combined hormone therapy group compared with the placebo group (diagnoses/year, 0.12% v 0.16%; hazard ratio [HR], 0.72; 95% CI, 0.56 to 0.94; P = .014). Bowel screening examinations were comparable between groups throughout. Cancers in the combined hormone therapy group more commonly had positive lymph nodes (50.5% v 28.6%; P < .001) and were at higher stage (regional or distant, 68.8% v 51.4%; P = .003). Although not statistically significant, there was a higher number of colorectal cancer deaths in the combined hormone therapy group (37 v 27 deaths; 0.04% v 0.03%; HR, 1.29; 95% CI, 0.78 to 2.11; P = .320). CONCLUSION The findings, suggestive of diagnostic delay, do not support a clinically meaningful benefit for combined hormone therapy on colorectal cancer.
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Affiliation(s)
- Michael S Simon
- Karmanos Cancer Institute, Wayne State University, Hudson Webber Cancer Research Building, 4221 HWCRC, 4100 John R, Detroit, MI 48201, USA.
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Menopausal hormone therapy and risks of colorectal adenomas and cancers in the French E3N prospective cohort: true associations or bias? Eur J Epidemiol 2012; 27:439-52. [DOI: 10.1007/s10654-012-9694-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 05/16/2012] [Indexed: 02/06/2023]
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Ortmann O, Lattrich C. The treatment of climacteric symptoms. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:316-23; quiz 324. [PMID: 22611453 DOI: 10.3238/arztebl.2012.0316] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 03/12/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Peri- and postmenopausal women commonly suffer from climacteric symptoms. In this article, we provide information to help physicians recognize climacteric symptoms and treat them appropriately. METHODS The information presented here is based on a selective search of the literature for pertinent articles that appeared from 2008 to early 2011, including the German S3 guideline on hormone therapy (HT) during and after menopause, which was published in 2009. RESULTS Perimenopausal women often suffer from climacteric symptoms. Typically, women undergoing menopause complain of heat waves and vaginal dryness. According to randomized controlled trials as well as national and international guidelines, HT is the most effective treatment for vasomotor symptoms and also improves vulvovaginal atrophy; for the latter indication, HT is preferably administered locally. Vaginal estrogen therapy lowers the frequency of recurrent urinary tract infections. However, HT is associated with an increased risk for a number of diseases, including stroke, thromboembolic events, gall-bladder diseases, and breast cancer. Alternative treatments for climacteric symptoms have little or no efficacy. CONCLUSION HT should only be used to treat climacteric symptoms after extensive patient education about its benefits and risks. Participatory decision-making is desirable. The generalized use of HT by all women with climacteric symptoms cannot be recommended.
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Affiliation(s)
- Olaf Ortmann
- Department of Obstretics and Gynecology, University Medical Center Regensburg, Germany.
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Green J, Czanner G, Reeves G, Watson J, Wise L, Roddam A, Beral V. Menopausal hormone therapy and risk of gastrointestinal cancer: nested case-control study within a prospective cohort, and meta-analysis. Int J Cancer 2011; 130:2387-96. [PMID: 21671473 DOI: 10.1002/ijc.26236] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 05/24/2011] [Indexed: 12/21/2022]
Abstract
Use of menopausal hormone therapy (HT) has been associated with reduced risk of colorectal cancer; evidence for its effect on other gastrointestinal cancers is limited. We conducted a nested case-control study within a UK cohort, and meta-analyses combining our results with those from published studies. Our study included women aged 50+ in the UK General Practice Research Database (GPRD): 1,054 with oesophageal, 750 with gastric and 4,708 with colorectal cancer, and 5 age- and practice-matched controls per case. Relative risks (RRs) and 95% confidence intervals (CIs) for cancer in relation to prospectively-recorded HT prescriptions were estimated by conditional logistic regression. Women prescribed HT had a reduced risk of oesophageal cancer (adjusted RR for 1+ vs. no HT prescriptions, 0.68, 95% CI 0.53-0.88; p = 0.004), gastric cancer (0.75, 0.54-1.05; p = 0.1) and colorectal cancer (0.81, 0.73-0.90; p < 0.001). There were no significant differences in cancer risk by HT type, estimated duration of HT use or between past and current users. In meta-analyses, risks for ever vs. never use of HT were significantly reduced for all three cancers (summary RR for oesophageal cancer, 0.68, 0.55-0.84, p < 0.001; for gastric cancer, 0.78, 0.65-0.94, p = 0.008; for colorectal cancer, 0.84, 0.81-0.88, p < 0.001). In high-income countries, estimated incidence over 5 years of these three cancers combined in women aged 50-64 was 2.9/1,000 in HT users and 3.6/1,000 in never users. The absolute reduction in risk of these cancers in HT users is small compared to the HT-associated increased risk of breast cancer.
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Chemoprevention of colorectal cancer: a role for ursodeoxycholic acid, folate and hormone replacement treatment? Best Pract Res Clin Gastroenterol 2011; 25:555-68. [PMID: 22122771 DOI: 10.1016/j.bpg.2011.09.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 09/13/2011] [Accepted: 09/14/2011] [Indexed: 02/08/2023]
Abstract
Chemoprevention of colorectal cancer has been an intense focus of research for many years. Among the possible candidate agents, ursodeoxycholic acid, folate, and hormone replacement therapy have been recently investigated with conflicting data. Experimental evidence shows that UDCA, folate and HRT target critical molecular events important for colon carcinogenesis. In animal models of sporadic, familial and inflammatory-associated cancers, they have shown to reduce colonic neoplasms. Observational studies have shown compelling evidence of possible protective effects of all three agents. However, randomised-controlled studies have yielded disappointing results, raising the issues of possible harm rather than protective effect for some of them. In this review experimental and clinical data on UDCA, folate and HRT as potential chemopreventive agents are discussed.
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Risks of colon and rectal adenomas are differentially associated with anthropometry throughout life: the French E3N prospective cohort. Int J Epidemiol 2011; 40:1269-79. [DOI: 10.1093/ije/dyr097] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Tsilidis KK, Allen NE, Key TJ, Bakken K, Lund E, Berrino F, Fournier A, Olsen A, Tjønneland A, Overvad K, Boutron-Ruault MC, Clavel-Chapelon F, Byrnes G, Chajes V, Rinaldi S, Chang-Claude J, Kaaks R, Bergmann M, Boeing H, Koumantaki Y, Stasinopoulou G, Trichopoulou A, Palli D, Tagliabue G, Panico S, Tumino R, Vineis P, Bueno-de-Mesquita HB, van Duijnhoven FJB, van Gils CH, Peeters PHM, Rodríguez L, González CA, Sánchez MJ, Chirlaque MD, Barricarte A, Dorronsoro M, Borgquist S, Manjer J, van Guelpen B, Hallmans G, Rodwell SA, Khaw KT, Norat T, Romaguera D, Riboli E. Oral contraceptives, reproductive history and risk of colorectal cancer in the European Prospective Investigation into Cancer and Nutrition. Br J Cancer 2010; 103:1755-9. [PMID: 21045829 PMCID: PMC2994229 DOI: 10.1038/sj.bjc.6605965] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 08/04/2010] [Accepted: 09/30/2010] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Oral contraceptive use and reproductive factors may initiate long-term changes to the hormonal milieu and thereby, possibly influence colorectal cancer risk. METHODS We examined the association of hormonal and reproductive factors with risk of colorectal cancer among 337,802 women in the European Prospective Investigation into Cancer and Nutrition, of whom 1878 developed colorectal cancer. RESULTS After stratification for center and age, and adjustment for body mass index, smoking, diabetes mellitus, physical activity and alcohol consumption, ever use of oral contraceptives was marginally inversely associated with colorectal cancer risk (hazard ratio (HR), 0.92; 95% confidence interval (CI), 0.83-1.02), although this association was stronger among post-menopausal women (HR, 0.84; 95% CI: 0.74-0.95). Duration of oral contraceptive use and reproductive factors, including age at menarche, age at menopause, type of menopause, ever having an abortion, parity, age at first full-term pregnancy and breastfeeding, were not associated with colorectal cancer risk. CONCLUSION Our findings provide limited support for a potential inverse association between oral contraceptives and colorectal cancer risk.
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Affiliation(s)
- K K Tsilidis
- Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Richard Doll Building, Roosevelt Drive, OX3 7LF Oxford, UK.
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