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Cardwell CR, Ranger TA, Labeit AM, Coupland CAC, Hicks B, Hughes C, McMenamin Ú, Mei XW, Murchie P, Hippisley-Cox J. Hormone replacement therapy and cancer mortality in women with 17 site-specific cancers: a cohort study using linked medical records. Br J Cancer 2024; 131:737-746. [PMID: 38914805 PMCID: PMC11333726 DOI: 10.1038/s41416-024-02767-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 06/11/2024] [Accepted: 06/14/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND There is limited evidence on the safety of Hormone Replacement Therapy (HRT) in women with cancer. Therefore, we systematically examined HRT use and cancer-specific mortality in women with 17 site-specific cancers. METHODS Women newly diagnosed with 17 site-specific cancers from 1998 to 2019, were identified from general practitioner (GP) records, hospital diagnoses or cancer registries in Scotland, Wales and England. Breast cancer patients were excluded because HRT is contraindicated in breast cancer patients. The primary outcome was time to cancer-specific mortality. Time-dependent Cox regression models were used to calculate adjusted hazard ratios (HR) and 95% confidence intervals (95% CIs) for cancer-specific mortality by systemic HRT use. RESULTS The combined cancer cohorts contained 182,589 women across 17 cancer sites. Overall 7% of patients used systemic HRT after their cancer diagnosis. There was no evidence that HRT users, compared with non-users, had higher cancer-specific mortality at any cancer site. In particular, no increase was observed in common cancers including lung (adjusted HR = 0.98 95% CI 0.90, 1.07), colorectal (adjusted HR = 0.79 95% CI 0.70, 0.90), and melanoma (adjusted HR = 0.77 95% CI 0.58, 1.02). CONCLUSIONS We observed no evidence of increased cancer-specific mortality in women with a range of cancers (excluding breast) receiving HRT.
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Affiliation(s)
- Chris R Cardwell
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK.
| | - Tom A Ranger
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Alexander M Labeit
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Carol A C Coupland
- Centre for Academic Primary Care, University of Nottingham, Nottingham, UK
| | - Blánaid Hicks
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Carmel Hughes
- School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Úna McMenamin
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Xue W Mei
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Peter Murchie
- Division of Applied Health Sciences Section, Academic Primary Care, University of Aberdeen, Foresterhill, Aberdeen, UK
| | - Julia Hippisley-Cox
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Caerts D, Garmyn M, Güvenç C. A Narrative Review of the Role of Estrogen (Receptors) in Melanoma. Int J Mol Sci 2024; 25:6251. [PMID: 38892441 PMCID: PMC11173079 DOI: 10.3390/ijms25116251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/27/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024] Open
Abstract
In this narrative review, we attempt to provide an overview of the evidence regarding the role of estrogen (receptors) in cutaneous melanoma (CM). We reviewed 68 studies and 4 systematic reviews and meta-analyses published from 2002 up to and including 2022. The prevailing presence of estrogen receptor β (ERβ) instead of estrogen receptor α (ERα) in CM is notable, with ERβ potentially playing a protective role and being less frequently detected in progressive cases. While men with CM generally experience a less favorable prognosis, this distinction may become negligible with advancing age. The role of oral contraceptives (OC) and hormone replacement therapy (HRT) in CM remains controversial. However, recent studies tend to associate the use of these exogenous hormones with a heightened risk of CM, mostly only when using estrogen therapy and not in combination with progesterone. On the contrary, the majority of studies find no substantial influence of in vitro fertilization (IVF) treatment on CM risk. Reproductive factors, including younger age at first childbirth, higher parity, and shorter reproductive life, show conflicting evidence, with some studies suggesting a lower CM risk. We suggest an important role for estrogens in CM. More research is needed, but the integration of estrogens and targeting the estrogen receptors in melanoma therapy holds promise for future developments in the field.
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Affiliation(s)
| | | | - Canan Güvenç
- Department of Dermatology, University Hospitals Leuven, 3000 Leuven, Belgium; (D.C.); (M.G.)
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3
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Ma J, Chen YH, Chiang CP, Wang WM, Chung CH, Tsao CH, Weng ZX, Hung CT, Chien WC. Hormone replacement therapy did not increase risk of melanoma in Chinese female with menopausal and postmenopausal disorders: A population-based retrospective cohort study in Taiwan. J Dermatol 2023; 50:1162-1169. [PMID: 37365983 DOI: 10.1111/1346-8138.16859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/18/2023] [Accepted: 05/29/2023] [Indexed: 06/28/2023]
Abstract
Hormone replacement therapy (HRT) is widely used to relieve symptoms of menopause with proven efficacy. However, there has been significant controversy surrounding the use of HRT because of its potential link with an increased risk of cancer, particularly female reproductive organ cancers. That HRT increases the risk of melanoma is also disputed, and several cohort studies have produced variable results. To delineate the association between HRT and melanoma in Taiwan, we conducted a population-based retrospective cohort study on 14 291 patients who had received HRT and 57 164 population controls in Taiwan between 2000 and 2013. Multivariate odds ratios (ORs) were calculated utilizing conditional logistic regression. Overall, the use of HRT was not significantly correlated with a higher risk of developing melanoma in Taiwan (95% confidence interval 0.386-1.099; p = 0.341). The hazard ratio analysis of melanoma and different HRTs showed there was no significant association between melanoma and the use of oral or external estrogens alone, including conjugated estrogens, estradiol, and estriol. Estrogen plus progesterone combined therapy was associated with a lower risk of melanoma. Only one case of melanoma was observed among the 2880 patients in this subgroup.
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Affiliation(s)
- Jun Ma
- Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Hsien Chen
- Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Ping Chiang
- Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Ming Wang
- Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Chang-Huei Tsao
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Microbiology & Immunology, National Defense Medical Center, Taipei, Taiwan
| | - Zi-Xeng Weng
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Tsung Hung
- Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
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4
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Kamal K, Young K, Ly S, Manjaly P, Xiang DH, Zhou G, Mostaghimi A, Theodosakis N. Investigating the association between gender minority identity and skin cancer prevalence: A cohort study in the United States All of Us research program. J Eur Acad Dermatol Venereol 2023; 37:e1151-e1153. [PMID: 37114382 PMCID: PMC10524765 DOI: 10.1111/jdv.19156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023]
Affiliation(s)
- K Kamal
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - K Young
- Harvard Medical School, Boston, Massachusetts, USA
| | - S Ly
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - P Manjaly
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - D H Xiang
- Harvard Medical School, Boston, Massachusetts, USA
| | - G Zhou
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - A Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - N Theodosakis
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
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5
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Fiol G, Lete I, Nieto L, Santaballa A, Pla MJ, Baquedano L, Calaf J, Coronado P, de la Viuda E, Llaneza P, Otero B, Sánchez-Méndez S, Ramírez I, Mendoza N. Associations between Menopausal Hormone Therapy and Colorectal, Lung, or Melanoma Cancer Recurrence and Mortality: A Narrative Review. J Clin Med 2023; 12:5263. [PMID: 37629305 PMCID: PMC10455141 DOI: 10.3390/jcm12165263] [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: 06/20/2023] [Revised: 07/31/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Objective: to develop eligibility criteria for use in non-gynecological cancer patients. Methods: We searched all the articles published in peer-reviewed journals up to March 2021. We utilized the PICOS standards and the following selection criteria: menopausal women with a history of non-gynecological and non-breast cancer who underwent hormone replacement therapy (HRT) using various preparations (oestrogens alone or in combination with a progestogen, tibolone, or tissue selective oestrogen complex) and different routes of administration (including oral, transdermal, vaginal, or intra-nasal). We focused on randomized controlled trials as well as relevant extension studies or follow-up reports, specifically examining recurrence and mortality outcomes. Results: Women colorectal cancer survivors who use MHT have a lower risk of death from any cause than those survivors who do not use MHT. Women who are skin melanoma survivors using MHT have a longer survival rate than non-MHT survivors. There is no evidence that women lung cancer survivors who use MHT have a different survival rate than those who do not use MHT. Conclusions: MHT is safe for women who have a history of colorectal, lung, or skin melanoma cancers.
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Affiliation(s)
- Gabriel Fiol
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia—AEEM), 28036 Madrid, Spain; (I.L.); (L.N.); (L.B.); (J.C.); (P.C.); (E.d.l.V.); (P.L.); (B.O.); (S.S.-M.); (I.R.); (N.M.)
| | - Iñaki Lete
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia—AEEM), 28036 Madrid, Spain; (I.L.); (L.N.); (L.B.); (J.C.); (P.C.); (E.d.l.V.); (P.L.); (B.O.); (S.S.-M.); (I.R.); (N.M.)
| | - Laura Nieto
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia—AEEM), 28036 Madrid, Spain; (I.L.); (L.N.); (L.B.); (J.C.); (P.C.); (E.d.l.V.); (P.L.); (B.O.); (S.S.-M.); (I.R.); (N.M.)
| | - Ana Santaballa
- Spanish Society of Medical Oncology (Sociedad Española de Oncología Médica), 28001 Madrid, Spain;
| | - María Jesús Pla
- Gynecological Oncology Section of the Spanish Society of Gynecology and Obstetrics (Sección de Oncología Ginecológica de la Sociedad Española de Ginecología y Obstetricia), 28036 Madrid, Spain;
| | - Laura Baquedano
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia—AEEM), 28036 Madrid, Spain; (I.L.); (L.N.); (L.B.); (J.C.); (P.C.); (E.d.l.V.); (P.L.); (B.O.); (S.S.-M.); (I.R.); (N.M.)
| | - Joaquín Calaf
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia—AEEM), 28036 Madrid, Spain; (I.L.); (L.N.); (L.B.); (J.C.); (P.C.); (E.d.l.V.); (P.L.); (B.O.); (S.S.-M.); (I.R.); (N.M.)
| | - Pluvio Coronado
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia—AEEM), 28036 Madrid, Spain; (I.L.); (L.N.); (L.B.); (J.C.); (P.C.); (E.d.l.V.); (P.L.); (B.O.); (S.S.-M.); (I.R.); (N.M.)
| | - Esther de la Viuda
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia—AEEM), 28036 Madrid, Spain; (I.L.); (L.N.); (L.B.); (J.C.); (P.C.); (E.d.l.V.); (P.L.); (B.O.); (S.S.-M.); (I.R.); (N.M.)
| | - Plácido Llaneza
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia—AEEM), 28036 Madrid, Spain; (I.L.); (L.N.); (L.B.); (J.C.); (P.C.); (E.d.l.V.); (P.L.); (B.O.); (S.S.-M.); (I.R.); (N.M.)
| | - Borja Otero
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia—AEEM), 28036 Madrid, Spain; (I.L.); (L.N.); (L.B.); (J.C.); (P.C.); (E.d.l.V.); (P.L.); (B.O.); (S.S.-M.); (I.R.); (N.M.)
| | - Sonia Sánchez-Méndez
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia—AEEM), 28036 Madrid, Spain; (I.L.); (L.N.); (L.B.); (J.C.); (P.C.); (E.d.l.V.); (P.L.); (B.O.); (S.S.-M.); (I.R.); (N.M.)
| | - Isabel Ramírez
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia—AEEM), 28036 Madrid, Spain; (I.L.); (L.N.); (L.B.); (J.C.); (P.C.); (E.d.l.V.); (P.L.); (B.O.); (S.S.-M.); (I.R.); (N.M.)
| | - Nicolas Mendoza
- Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia—AEEM), 28036 Madrid, Spain; (I.L.); (L.N.); (L.B.); (J.C.); (P.C.); (E.d.l.V.); (P.L.); (B.O.); (S.S.-M.); (I.R.); (N.M.)
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6
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Kaszuba A, Sławińska M, Żółkiewicz J, Sobjanek M, Nowicki RJ, Lange M. Mastocytosis and Skin Cancer: The Current State of Knowledge. Int J Mol Sci 2023; 24:9840. [PMID: 37372988 DOI: 10.3390/ijms24129840] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
Mastocytosis is a heterogeneous group of diseases associated with excessive proliferation and accumulation of mast cells in different organs. Recent studies have demonstrated that patients suffering from mastocytosis face an increased risk of melanoma and non-melanoma skin cancer. The cause of this has not yet been clearly identified. In the literature, the potential influence of several factors has been suggested, including genetic background, the role of cytokines produced by mast cells, iatrogenic and hormonal factors. The article summarizes the current state of knowledge regarding the epidemiology, pathogenesis, diagnosis, and management of skin neoplasia in mastocytosis patients.
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Affiliation(s)
- Agnieszka Kaszuba
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Smoluchowskiego Street 17, 80-214 Gdańsk, Poland
| | - Martyna Sławińska
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Smoluchowskiego Street 17, 80-214 Gdańsk, Poland
| | - Jakub Żółkiewicz
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Smoluchowskiego Street 17, 80-214 Gdańsk, Poland
| | - Michał Sobjanek
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Smoluchowskiego Street 17, 80-214 Gdańsk, Poland
| | - Roman J Nowicki
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Smoluchowskiego Street 17, 80-214 Gdańsk, Poland
| | - Magdalena Lange
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Smoluchowskiego Street 17, 80-214 Gdańsk, Poland
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Lallas K, Anagnostis P, Theocharis P, Boureka E, Kyrgidis A, Klonos E, Papazisis G, Apalla Z, Lallas A, Vakirlis E. The effect of menopausal hormone therapy on the risk of melanoma and keratinocyte skin cancer: A systematic review and meta-analysis of observational studies. Maturitas 2023; 168:20-28. [PMID: 36372010 DOI: 10.1016/j.maturitas.2022.10.010] [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: 03/23/2022] [Revised: 09/10/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Whether menopausal hormone therapy (MHT) increases the risk of skin cancer is controversial. AIM To systematically review and meta-analyze evidence regarding the association of MHT with the risk of melanoma and keratinocyte cancer (KC). MATERIAL AND METHODS A comprehensive literature search was conducted of the PubMed, Scopus and Cochrane databases, through to 30 October 2021. Skin neoplasms were divided into melanoma and KC. In the latter category, both basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) were considered. The results are presented as hazard ratios (HR) with 95 % confidence intervals (CI). The I2 index was used to assess heterogeneity. Subgroup analysis and sensitivity analysis were also conducted in order to explore potential differences among studies. RESULTS Twenty-seven studies were included in the qualitative and 23 in the quantitative analysis, with a total of 2,612,712 menopausal women (25,126 with skin cancer; 20,150 with melanoma). MHT was associated with an increased risk of melanoma (HR 1.11; 95 % CI 1.05-1.19; I2 45%). With regard to MHT type, both estrogen monotherapy (HR 1.22, 95 % CI 1.16-1.29; I2 0%) and estrogen in combination with progestogen (HR 1.11, 95 % CI 1.05-1.18, I2 26%) significantly increased that risk. Regarding melanoma subtype, superficial spreading melanoma (SSM) and lentigo maligna melanoma (LMM) were the only histologic subtypes associated with MHT use. MHT was also associated with an increased risk of KC (HR 1.17, 95 % CI 1.04-1.31, I2 83%), specifically BCC (HR 1.22, 95 % CI 1.12-1.32; I2 29%). Longer duration (>5 years) of MHT, current use and estrogen monotherapy were associated with an increased KC risk compared with no use. CONCLUSION The use of MHT by postmenopausal women was associated with an increased risk of melanoma and KC. This risk was higher for current MHT users and those treated for over 5 years.
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Affiliation(s)
- Konstantinos Lallas
- Department of Medical Oncology, Papageorgiou General Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece.
| | - Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Eirini Boureka
- 3rd Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - Athanasios Kyrgidis
- Department of Oral & Maxillofacial Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki "George Papanikolaou", Thessaloniki, Greece
| | - Eleftherios Klonos
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Papazisis
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - Zoe Apalla
- Second Dermatology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aimilios Lallas
- First Dermatology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efstratios Vakirlis
- First Dermatology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Chiavarini M, Naldini G, Giacchetta I, Fabiani R. Exogenous Hormone Factors in Relation to the Risk of Malignant Melanoma in Women: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14133192. [PMID: 35804961 PMCID: PMC9264834 DOI: 10.3390/cancers14133192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/18/2022] [Accepted: 06/21/2022] [Indexed: 02/04/2023] Open
Abstract
The influence of exogenous female hormones on the risk of developing malignant melanoma in women remains controversial. The aim of our review and meta-analysis is to summarize the evidence and derive a more accurate estimation of the association between oral contraceptives (OCs) or menopausal hormone therapy (MHT) and the risk of developing malignant melanoma in women. PubMed, Web of Science, and Scopus database were searched for studies published up until October 2021. The PRISMA statement and MOOSE guidelines were followed. Studies were pooled using a random effects model. Heterogeneity was explored with the chi-square-based Cochran’s Q statistic and the I2 statistic. Publication bias was assessed with Begg’s test and Egger’s test. Forty-six studies met the eligibility criteria. The pooled analysis (26 studies) on OC use and the risk of developing cutaneous malignant melanoma (CMM) showed no significant association, but demonstrated significant association for cohort studies (OR 1.08, 95% CI 1.01–1.16; I2 = 0.00%, p = 0.544). The pooled analysis (16 studies) showed a significantly increased risk of CMM in association with MHT (OR 1.15, 95% CI 1.08–1.23; I2 = 25.32%, p = 0.169). Stratifying the results by study design showed that a significant increased risk of CMM was associated with MHT in the cohort studies (OR 1.12; 95% CI 1.04–1.19; I2 = 0%, p = 0.467). No significant publication bias could be detected. Further studies are needed to investigate the potential association with formulation, duration of use, and dosage of use, and to better understand the role of possible confounders.
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Affiliation(s)
- Manuela Chiavarini
- Department of Experimental Medicine, Section of Public Heath, University of Perugia, 06129 Perugia, Italy;
| | - Giulia Naldini
- School of Specialization in Hygiene and Preventive Medicine, University of Perugia, 06129 Perugia, Italy;
| | - Irene Giacchetta
- School of Specialization in Hygiene and Preventive Medicine, University of Perugia, 06129 Perugia, Italy;
- Correspondence:
| | - Roberto Fabiani
- Department of Chemistry, Biology and Biotechnology, University of Perugia, 06129 Perugia, Italy;
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9
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Hormone therapy and melanoma in women. Int J Womens Dermatol 2022; 7:692-696. [PMID: 35028367 PMCID: PMC8714603 DOI: 10.1016/j.ijwd.2021.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/01/2021] [Accepted: 06/22/2021] [Indexed: 11/20/2022] Open
Abstract
Melanocytes are known to respond to estrogen stimulation. Knowledge of estrogen therapy in melanoma tumor behavior is essential to inform accurate patient prognostication. There is limited evidence to suggest oral contraception and fertility treatments affect melanoma incidence. The effect of menopausal hormone therapy on melanoma risk requires further investigation with multinational studies.
Although primary cutaneous melanoma accounts for approximately 3% of all malignant skin tumors, it has the greatest contribution to skin cancer–related death. Sex-specific differences in melanoma tumor behavior have been described, and melanoma pathogenesis may be hormonally mediated. This review aims to summarize the literature to date regarding the effects of hormone therapy on melanoma in women. Women's exogenous hormone use has changed dramatically over the past few decades. Thus, we focus on studies investigating the associations between oral contraception, fertility treatments, menopausal hormone therapy (MHT), and melanoma. Across hormone therapy types, there does not appear to be a well-established association between exogenous female hormones and melanoma incidence. However, MHT practices and formulations vary significantly across countries. Although MHT does not appear to increase melanoma risk in studies from the United States, conflicting results have been observed in Europe. Unopposed estrogen MHT formulations require further investigation to determine a clear pattern between hormone use and the development of melanoma.
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10
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Chiavarini M, Naldini G, Giacchetta I, Fabiani R. Postmenopausal exogenous hormone therapy and Melanoma risk in women: A systematic review and time-response meta-analysis. Pharmacol Res 2022; 176:106054. [PMID: 34979234 DOI: 10.1016/j.phrs.2021.106054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Manuela Chiavarini
- Department of Experimental Medicine, Section of Public Heath, University of Perugia, Perugia, Italy.
| | - Giulia Naldini
- School of Specialization in Hygiene and Preventive Medicine, University of Perugia, Perugia, Italy.
| | - Irene Giacchetta
- School of Specialization in Hygiene and Preventive Medicine, University of Perugia, Perugia, Italy.
| | - Roberto Fabiani
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia, Italy.
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11
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Sex-Based Differences in the Tumor Microenvironment. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1329:499-533. [PMID: 34664253 DOI: 10.1007/978-3-030-73119-9_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Cancers are heterogeneous multifactorial diseases consisting of a major public health issue worldwide. Sex disparities are evidenced in cancer incidence, mortality, expression of prognosis factor, response to treatment, and survival. For both sexes, an interplay of intrinsic and environmental factors influences cancer cells and tumor microenvironment (TME) components. The TME cumulates both supportive and communicative functions, contributing to cancer development, progression, and metastasis dissemination. The frontline topics of this chapter are focused on the contribution of sex, via steroid hormones, such as estrogens and androgens, on the following components of the TME: cancer-associated fibroblasts (CAFs), extracellular matrix (ECM), blood and lymphatic endothelial cells, and immunity/inflammatory system.
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Ranger TA, Burchardt J, Clift AK, Mei WX, Coupland C, Tan PS, Dixon S, Cardwell CR, Hippisley-Cox J. Hormone replacement therapy and cancer survival: a longitudinal cohort study: protocol paper. BMJ Open 2021; 11:e046701. [PMID: 34341043 PMCID: PMC8330592 DOI: 10.1136/bmjopen-2020-046701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 06/30/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Hormone replacement therapy (HRT) can help women experiencing menopausal symptoms, but usage has declined due to uncertainty around risks of cancer and some cardiovascular diseases (CVD). Moreover, improved cancer survival rates mean that more women who survive cancer go on to experience menopausal symptoms. Understanding these relationships is important so that women and their clinicians can make informed decisions around the risks and benefits of HRT. This study's primary aim is to determine the association between HRT use after cancer diagnosis and the risk of cancer-specific mortality. The secondary aims are to investigate the risks of HRT on subsequent cancer, all-cause mortality and CVD. METHODS AND ANALYSIS We will conduct a population-based longitudinal cohort study of 18-79 year-old women diagnosed with cancer between 1998 and 2020, using the QResearch database. The main exposure is HRT use, categorised based on compound, dose and route of administration, and modelled as a time-varying covariate. Analysis of HRT use precancer and postcancer diagnosis will be conducted separately. The primary outcome is cancer-specific mortality, which will be stratified by cancer site. Secondary outcomes include subsequent cancer diagnosis, CVD (including venous thrombo-embolism) and all-cause mortality. Adjustment will be made for key confounders such as age, body mass index, ethnicity, deprivation index, comorbidities, and cancer grade, stage and treatment. Statistical analysis will include descriptive statistics and Cox proportional hazards models to calculate HRs and 95% CIs. ETHICS AND DISSEMINATION Ethical approval for this project was obtained from the QResearch Scientific Committee (Ref: OX24, project title 'Use of hormone replacement therapy and survival from cancer'). This project has been, and will continue to be, supported by patient and public involvement panels. We intend to the submit the findings for peer-reviewed publication in an academic journal and disseminate them to the public through Cancer Research UK.
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Affiliation(s)
- Tom Alan Ranger
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Judith Burchardt
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ashley Kieran Clift
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Winnie Xue Mei
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Carol Coupland
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Pui San Tan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sharon Dixon
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Julia Hippisley-Cox
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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McMenamin Ú, Hicks B, Hughes C, Murchie P, Hippisley-Cox J, Ranger T, Coupland C, Cardwell C. Hormone replacement therapy in women with cancer and risk of cancer-specific mortality and cardiovascular disease: a protocol for a cohort study from Scotland and Wales. BMC Cancer 2021; 21:313. [PMID: 33761919 PMCID: PMC7992792 DOI: 10.1186/s12885-021-08065-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hormone replacement therapy (HRT) is widely used and has proven benefits for women with menopausal symptoms. An increasing number of women with cancer experience menopausal symptoms but the safety of HRT use in women with cancer is unclear. There are particular concerns that HRT could accelerate cancer progression in women with cancer, and also that HRT could increase the risk of cardiovascular disease in such women. Therefore, our primary aim is to determine whether HRT use alters the risk of cancer-specific mortality in women with a range of common cancers. Our secondary objectives are to investigate whether HRT alters the risk of second cancers, cardiovascular disease, venous thromboembolism and all-cause mortality. METHODS The study will utilise independent population-based data from Wales using the SAIL databank and Scotland based upon the national Prescribing Information System. The study will include women newly diagnosed with common cancers from 2000 to 2016, identified from cancer registries. Women with breast cancers will be excluded. HRT will be ascertained using electronic prescribing in Wales or dispensing records in Scotland. The primary outcome will be time to cancer-specific mortality from national mortality records. Time-dependent cox regression models will be used to calculate hazard ratios (HR) and 95% confidence intervals (95% CIs) for cancer specific death in HRT users compared with non-users after cancer diagnosis after adjusting for relevant confounders, stratified by cancer site. Analysis will be repeated investigating the impact of HRT use immediately before cancer diagnosis. Secondary analyses will be conducted on the risk of second cancers, cardiovascular disease, venous thromboembolism and all-cause mortality. Analyses will be conducted within each cohort and pooled across cohorts. DISCUSSION Our study will provide evidence to inform guidance given to women diagnosed with cancer on the safety of HRT use and/or guide modifications to clinical practice.
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Affiliation(s)
- Úna McMenamin
- Centre for Public Health, ICSB, Queen's University Belfast, Royal Victoria Hospital, Belfast, Ireland, BT12 6BA
| | - Blánaid Hicks
- Centre for Public Health, ICSB, Queen's University Belfast, Royal Victoria Hospital, Belfast, Ireland, BT12 6BA
| | - Carmel Hughes
- School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland
| | - Peter Murchie
- Division of Applied Health Sciences Section, Academic Primary Care, Foresterhill, Aberdeen, UK
| | - Julia Hippisley-Cox
- Primary Care Epidemiology, Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Tom Ranger
- Primary Care Epidemiology, Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Carol Coupland
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Chris Cardwell
- Centre for Public Health, ICSB, Queen's University Belfast, Royal Victoria Hospital, Belfast, Ireland, BT12 6BA.
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Sun Q, Sun H, Cong L, Zheng Y, Wu N, Cong X. Effects of Exogenous Hormones and Reproductive Factors on Female Melanoma: A Meta-Analysis. Clin Epidemiol 2020; 12:1183-1203. [PMID: 33149695 PMCID: PMC7605627 DOI: 10.2147/clep.s273566] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/30/2020] [Indexed: 12/30/2022] Open
Abstract
Epidemiological findings on the effects of hormones on melanoma risk have been inconsistent. We therefore conducted a meta-analysis to examine the relationship between exogenous hormonal and reproductive factors and the risk of melanoma in women. We performed a search of PubMed, Web of Science, and the China National Knowledge Infrastructure (CNKI) database through April 2020 for relevant studies. Based on heterogeneity, we performed the meta-analysis of the risk estimates using either fixed effect or random effect models. We identified 38 studies that met the analytical criteria, involving 3,571,910 participants. The results showed that long-term use of oral contraceptives (OC) may increase the risk of melanoma in women (≥5 years [pooled RR=1.18; 95% CI: 1.07-1.31; I2=0%] and ≥10 years [pooled RR=1.25; 95% CI: 1.06-1.48; I2=0%]). Women who first used OC 15-19 years previously were more likely to develop melanoma (pooled RR=1.52; 95% CI: 1.03-2.24; I2=0%), while the years since the last use and the age at first use were not associated with the development of melanoma in women. Hormone replacement therapy (HRT) increased the incidence of melanoma in women (pooled RR=1.12, 95% CI: 1.02-1.24; I2=50%) and was especially associated with an increased risk of superficial spreading melanoma (SSM) (pooled RR=1.26; 95% CI: 1.17-1.37; I2=0%), and estrogen and estradiol may be the main active agents that contribute to the increased risk of melanoma, but these results may be due to a combination of sun exposure factors. With regard to reproductive factors, decreased parity and being aged ≥20 years at first birth may be associated with an increased risk of melanoma in females, while menopausal status and age at menarche are not associated with the incidence of melanoma in females. Further large-scale prospective studies are necessary to reveal new pathophysiological mechanisms and new therapeutic targets for cutaneous melanoma.
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Affiliation(s)
- Qian Sun
- Department of Dermatology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Hongyan Sun
- Tissue Bank, China-Japan Union Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Lele Cong
- Department of Dermatology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Yang Zheng
- Department of Dermatology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Nan Wu
- Department of Dermatology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Xianling Cong
- Department of Dermatology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, People's Republic of China
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Bellenghi M, Puglisi R, Pontecorvi G, De Feo A, Carè A, Mattia G. Sex and Gender Disparities in Melanoma. Cancers (Basel) 2020; 12:E1819. [PMID: 32645881 PMCID: PMC7408637 DOI: 10.3390/cancers12071819] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/22/2020] [Accepted: 07/03/2020] [Indexed: 12/19/2022] Open
Abstract
Worldwide, the total incidence of cutaneous melanoma is higher in men than in women, with some differences related to ethnicity and age and, above all, sex and gender. Differences exist in respect to the anatomic localization of melanoma, in that it is more frequent on the trunk in men and on the lower limbs in women. A debated issue is if-and to what extent-melanoma development can be attributed to gender-specific behaviors or to biologically intrinsic differences. In the search for factors responsible for the divergences, a pivotal role of sex hormones has been observed, although conflicting results indicate the involvement of other mechanisms. The presence on the X chromosome of numerous miRNAs and coding genes playing immunological roles represents another important factor, whose relevance can be even increased by the incomplete X chromosome random inactivation. Considering the known advantages of the female immune system, a different cancer immune surveillance efficacy was suggested to explain some sex disparities. Indeed, the complexity of this picture emerged when the recently developed immunotherapies unexpectedly showed better improvements in men than in women. Altogether, these data support the necessity of further studies, which consider enrolling a balanced number of men and women in clinical trials to better understand the differences and obtain actual gender-equitable healthcare.
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Affiliation(s)
- Maria Bellenghi
- Center for Gender-specific Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.B.); (R.P.); (G.P.); (G.M.)
| | - Rossella Puglisi
- Center for Gender-specific Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.B.); (R.P.); (G.P.); (G.M.)
| | - Giada Pontecorvi
- Center for Gender-specific Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.B.); (R.P.); (G.P.); (G.M.)
| | - Alessandra De Feo
- Laboratory of Experimental Oncology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
| | - Alessandra Carè
- Center for Gender-specific Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.B.); (R.P.); (G.P.); (G.M.)
| | - Gianfranco Mattia
- Center for Gender-specific Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.B.); (R.P.); (G.P.); (G.M.)
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