Hormone replacement therapy and cancer

Hormone replacement therapy after invasive ovarian serous cystadenocarcinoma treatment: the effect on survival

AIM

Our report deals with the presumed influence of hormone replacement therapy (HRT) on the survival of patients with invasive ovarian serous cystadenocarcinoma.

MATERIALS AND METHODS

We selected a group of 24 patients with the diagnosis of invasive ovarian serous cystadenocarcinoma who were treated with HRT after primary surgical treatment. Each patient from the selected group was compared with two patients from the control group with the same diagnosis who did not receive HRT. The matching criteria were the age at the time of the diagnosis, year of the diagnosis, stage of the disease, differentiation, residual tumor after first operation, and disease-free interval until receiving HRT. We used Cox regression to calculate odds ratios as estimates of the effect of HRT on overall survival in the patients with invasive ovarian serous cystadenocarcinoma who did or did not receive HRT after diagnosis.

RESULTS

HRT was started an average of 21 months (range, 1-25 months) after diagnosis, and lasted for an average of 24 months (range, 1-70 months). After taking into account the effects of other known prognostic factors (the age at the time of the diagnosis, stage of the disease, differentiation, type of operation, residual tumour before the first operation), the estimated risk of death in patients with invasive ovarian serous cystadenocarcinoma who received HRT was 0.90 (odds ratio = 0.90; 95% confidence interval, 0.24-5.08).

CONCLUSION

The results of our small study are only preliminary and suggest that HRT does not have a pronounced effect on survival. A single center can scarcely obtain a sufficient number of such a specific group of cancer patients; therefore, the collaboration of different institutions, preferably in a randomized, controlled trial, is needed for more reliable results.

Androgenic progestogens oppose the decrease of insulin-like growth factor I serum level induced by conjugated oestrogens in postmenopausal women. Preliminary report

Oral oestrogen treatment in postmenopausal women causes a decrease of insulin-like growth factor I (IGF-I) serum level, probably through a hepatocellular effect. To explore the possibility that the androgenic progestogens oppose this effect, serum IGF-I and sex hormone binding globulin (SHBG) were evaluated in two groups of patients treated respectively with oral conjugated oestrogens (oCE) or transdermal oestradiol (tdE2), in a first phase with the addition of dydrogesterone (DYDR), a non-androgenic progestogen, and subsequently with the addition of norethisterone acetate (NETA). With respect to basal values, treatment with oCE+DYDR caused an increase of SHBG (P < 0.002) and a decrease of IGF-I serum levels (P < 0.05); the shift to NETA addition opposed both effects: SHBG levels decreased partially but significantly (P < 0.01 vs. oCE + DYDR) and IGF-I returned to basal values with a significant increase with respect to the oCE + DYDR phase (P < 0.02). No changes were observed in the tdE2 + DYDR treated women; in this group the shift to NETA addition caused a significant decrease of SHBG values (P < 0.001 vs. before treatment and vs. tdE2 + DYDR phase) and a slight increase of IGF-I values. These differential effects on IGF-I and SHBG serum levels might be relevant as far as breast cancer risk is concerned.

The prevention of cardiovascular disease. Emphasis on secondary prevention

Atherosclerosis is a progressive disease affecting all major arteries. Clinical evidence of atherosclerosis increases the risk of subsequent morbid and mortal events fivefold to sevenfold over the next 5 to 10 years. The same risk factors contribute to the initial development of CVD events as to their recurrence. Both coronary and noncoronary events, such as stroke or PAD, reflect the severity of the underlying atherosclerotic process and strongly predict future excess CVD morbidity and mortality. Short-term and long-term survival depends on modifying the risk factors that contribute to CVD events. Although absolute proof of benefit for secondary prevention does not exist for all risk factors, the data from primary prevention trials and the secondary prevention trials that have been done argue strongly for aggressive intervention. Benefit has been demonstrated for smoking cessation, cholesterol reduction, and blood pressure control. Selected patients may benefit from additional medical, procedural, or surgical interventions to prolong life, such as beta-blocking agents, aspirin, or carotid endarterectomy. Many secondary prevention measures are a cost-effective way to reduce the substantial morbidity and mortality due to CVD. Contrary to primary prevention, even modest treatment effects from secondary prevention efforts can benefit large numbers of patients. Finally, secondary prevention may be more successful because patients with clinical evidence of CVD may be more highly motivated than their healthy counterparts to make and maintain lifestyle changes.