La diminution de l’utilisation du traitement hormonal de la ménopause a-t-elle fait baisser l’incidence du cancer du sein en France (et ailleurs) ?

Risk of breast cancer after stopping menopausal hormone therapy in the E3N cohort

Questions remain on how the excess risk of breast cancer associated with menopausal hormone therapy (MHT) evolves after treatment stops. We investigated that issue in the E3N cohort, with 3,678 invasive breast cancers identified between 1992 and 2008 among 78,353 women (881,290 person-years of postmenopausal follow-up). Exposure to MHT was assessed through biennial self-administered questionnaires and classified by type of progestagen component (progesterone or dydrogesterone; other progestagen), duration (short-term ≤5 years; long-term >5 years) and time since last use (current, 3 months-5 years, 5-10 years, 10+ years). Hazard ratios (HR) and confidence intervals (CI) were estimated with Cox models. Among short-term users, only those currently using estrogens associated with a progestagen other than progesterone/dydrogesterone had a significantly elevated breast cancer risk (HR 1.70, 95 % CI 1.50-1.91, compared with never users). Long-term use of this type of MHT was associated with a HR of 2.02 (1.81-2.26) when current and of 1.36 (1.13-1.64), 1.34 (1.04-1.73), and 1.52 (0.87-2.63) when stopped ≤5, 5-10, and 10+ years earlier, respectively. Our results suggest residual increases in breast cancer risk several years after MHT cessation, which are restricted to long-term treatments. Whether increases persist more than 10 years after cessation deserves continuing investigation.

Cancer incidence and mortality in France over the 1980-2012 period: solid tumors

BACKGROUND

Cancer incidence and mortality estimates for 19 cancers (among solid tumors) are presented for France between 1980 and 2012.

METHODS

Incidence data were collected from 21 local registries and correspond to invasive cancers diagnosed between 1975 and 2009. Mortality data for the same period were provided by the Institut national de la santé et de la recherche médicale. The national incidence estimates were based on the use of mortality as a correlate of incidence. The observed incidence and mortality data were modeled using an age-period-cohort model. The numbers of incident cases and deaths for 2010-2012 are the result of short-term projections.

RESULTS

In 2012, the study estimated that 355,000 new cases of cancer (excluding non-melanoma skin cancer) and 148,000 deaths from cancer occurred in France. The incidence trend was not linear over the study period. After a constant increase from 1980 onwards, the incidence of cancer in men declined between 2005 and 2012. This recent decrease is largely related to the reduction in the incidence of prostate cancer. In women, the rates stabilized, mainly due to a change in breast cancer incidence. Mortality from most cancer types declined over the study period. A combined analysis of incidence and mortality by cancer site distinguished cancers with declining incidence and mortality (e.g., stomach) and cancers with increasing incidence and mortality (e.g., lung cancer in women). Some other cancers had rising incidence but declining mortality (e.g., thyroid).

CONCLUSION

This study reveals recent changes in cancer incidence trends, particularly regarding breast and prostate cancers.

Should transdermal rather than oral estrogens be used in menopausal hormone therapy? A review

The current evaluation of the benefit/risk ratio associated with menopausal hormone therapy (MHT) use is largely based on clinical trials which investigated the effects of oral treatments. Would MHT with transdermal estrogens be associated with a more favourable benefit/risk ratio? We reviewed the available epidemiologic evidence on that question. Epidemiologic studies were considered if they provided risk estimates of conditions which carry an important weight among menopausal women, and for which epidemiologic evidence of a possible link with MHT use is convincing: cardiovascular diseases, breast cancer, diabetes, colorectal cancer and hip fracture. We did not include studies with only surrogate measures. We found that the available information on the potential impact of the route of administration of MHT on the risk of our selected outcomes is limited. To date, epidemiologic data suggest that it has no impact on the risk of breast cancer and hip fracture. Results on the risk of coronary heart disease and colorectal cancer are inconsistent. Studies on stroke and diabetes risk are too few to allow meaningful conclusions. There is a suggestion that transdermal MHT may be less deleterious than oral MHT regarding venous thromboembolism which needs to be confirmed. The issue of the route of administration of MHT should remain an active area of research as part of an attempt to identify treatment modalities that would have the least potential for exerting adverse effects.