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Estrogen plus progestin and colorectal cancer in postmenopausal women.

Abstract

BACKGROUND

Although the Women's Health Initiative (WHI) trial of estrogen plus progestin in postmenopausal women identified more overall health risks than benefits among women in the hormone group, the use of estrogen plus progestin was associated with a significant decrease in the risk of colorectal cancer. We analyzed features of the colorectal cancers that developed and their relation to the characteristics of the participants.

METHODS

In the WHI trial, 16,608 postmenopausal women who were 50 to 79 years of age and had an intact uterus were randomly assigned to a combination of conjugated equine estrogens (0.625 mg per day) plus medroxyprogesterone acetate (2.5 mg per day) or placebo. The main outcome measures were the incidence, stages, and types of colorectal cancer, as determined by blinded central adjudication.

RESULTS

There were 43 invasive colorectal cancers in the hormone group and 72 in the placebo group (hazard ratio, 0.56; 95 percent confidence interval, 0.38 to 0.81; P=0.003). The invasive colorectal cancers in the hormone group were similar in histologic features and grade to those in the placebo group but with a greater number of positive lymph nodes (mean +/-SD, 3.2+/-4.1 vs. 0.8+/-1.7; P=0.002) and were more advanced (regional or metastatic disease, 76.2 percent vs. 48.5 percent; P=0.004). In exploratory analyses, women in the hormone group with antecedent vaginal bleeding had colorectal cancers with a greater number of positive nodes than women in the hormone group who did not have vaginal bleeding (3.8+/-4.3 vs. 0.7+/-1.5 nodes, P=0.006).

CONCLUSIONS

Relatively short-term use of estrogen plus progestin was associated with a decreased risk of colorectal cancer. However, colorectal cancers in women who took estrogen plus progestin were diagnosed at a more advanced stage than those in women who took placebo.

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  • Authors+Show Affiliations

    ,

    Department of Medicine, Harbor-UCLA Research and Education Institute, Torrance, Calif 90502, USA. rchlebowski@rei.edu

    , , , , , , , , , , ,

    Source

    The New England journal of medicine 350:10 2004 Mar 04 pg 991-1004

    MeSH

    Aged
    Colorectal Neoplasms
    Estrogen Replacement Therapy
    Estrogens, Conjugated (USP)
    Female
    Follow-Up Studies
    Humans
    Incidence
    Medroxyprogesterone Acetate
    Middle Aged
    Neoplasm Staging
    Postmenopause
    Uterine Hemorrhage

    Pub Type(s)

    Clinical Trial
    Journal Article
    Multicenter Study
    Randomized Controlled Trial
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    14999111

    Citation

    Chlebowski, Rowan T., et al. "Estrogen Plus Progestin and Colorectal Cancer in Postmenopausal Women." The New England Journal of Medicine, vol. 350, no. 10, 2004, pp. 991-1004.
    Chlebowski RT, Wactawski-Wende J, Ritenbaugh C, et al. Estrogen plus progestin and colorectal cancer in postmenopausal women. N Engl J Med. 2004;350(10):991-1004.
    Chlebowski, R. T., Wactawski-Wende, J., Ritenbaugh, C., Hubbell, F. A., Ascensao, J., Rodabough, R. J., ... White, E. (2004). Estrogen plus progestin and colorectal cancer in postmenopausal women. The New England Journal of Medicine, 350(10), pp. 991-1004.
    Chlebowski RT, et al. Estrogen Plus Progestin and Colorectal Cancer in Postmenopausal Women. N Engl J Med. 2004 Mar 4;350(10):991-1004. PubMed PMID: 14999111.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Estrogen plus progestin and colorectal cancer in postmenopausal women. AU - Chlebowski,Rowan T, AU - Wactawski-Wende,Jean, AU - Ritenbaugh,Cheryl, AU - Hubbell,F Allan, AU - Ascensao,Joao, AU - Rodabough,Rebecca J, AU - Rosenberg,Carol A, AU - Taylor,Victoria M, AU - Harris,Randall, AU - Chen,Chu, AU - Adams-Campbell,Lucile L, AU - White,Emily, AU - ,, PY - 2004/3/5/pubmed PY - 2004/3/10/medline PY - 2004/3/5/entrez SP - 991 EP - 1004 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 350 IS - 10 N2 - BACKGROUND: Although the Women's Health Initiative (WHI) trial of estrogen plus progestin in postmenopausal women identified more overall health risks than benefits among women in the hormone group, the use of estrogen plus progestin was associated with a significant decrease in the risk of colorectal cancer. We analyzed features of the colorectal cancers that developed and their relation to the characteristics of the participants. METHODS: In the WHI trial, 16,608 postmenopausal women who were 50 to 79 years of age and had an intact uterus were randomly assigned to a combination of conjugated equine estrogens (0.625 mg per day) plus medroxyprogesterone acetate (2.5 mg per day) or placebo. The main outcome measures were the incidence, stages, and types of colorectal cancer, as determined by blinded central adjudication. RESULTS: There were 43 invasive colorectal cancers in the hormone group and 72 in the placebo group (hazard ratio, 0.56; 95 percent confidence interval, 0.38 to 0.81; P=0.003). The invasive colorectal cancers in the hormone group were similar in histologic features and grade to those in the placebo group but with a greater number of positive lymph nodes (mean +/-SD, 3.2+/-4.1 vs. 0.8+/-1.7; P=0.002) and were more advanced (regional or metastatic disease, 76.2 percent vs. 48.5 percent; P=0.004). In exploratory analyses, women in the hormone group with antecedent vaginal bleeding had colorectal cancers with a greater number of positive nodes than women in the hormone group who did not have vaginal bleeding (3.8+/-4.3 vs. 0.7+/-1.5 nodes, P=0.006). CONCLUSIONS: Relatively short-term use of estrogen plus progestin was associated with a decreased risk of colorectal cancer. However, colorectal cancers in women who took estrogen plus progestin were diagnosed at a more advanced stage than those in women who took placebo. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/14999111/full_citation L2 - https://www.nejm.org/doi/10.1056/NEJMoa032071?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=www.ncbi.nlm.nih.gov DB - PRIME DP - Unbound Medicine ER -