Rowan T Chlebowski1, Heather Wakelee2, Mary Pettinger3, Thomas Rohan4, Jingmin Liu3, Michael Simon5, Hilary Tindle6, Catherine Messina2, Karen Johnson7, Ann Schwartz8, Margery Gass9, Jean Wactawski-Wende10. 1. Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA. Electronic address: rowanchlebowski@gmail.com. 2. Stanford School of Medicine, Stanford, CA. 3. Fred Hutchinson Cancer Research Center, Public Health Sciences, Seattle, WA. 4. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY. 5. Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI. 6. The University of Pittsburgh, Pittsburgh, PA. 7. The University of Tennessee Health Science Center, Memphis, TN. 8. The University of California San Francisco, San Francisco, CA. 9. The North American Menopause Society, Maryland Heights, OH. 10. University of Buffalo, School of Public Health and Health Professions, Buffalo, NY.
Abstract
INTRODUCTION: In the Women's Health Initiative (WHI) estrogen plus progestin trial, after 5.6 years' intervention and 8 years' median follow-up, more women died from lung cancer in the hormone therapy group (hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.16-2.52; P = .01). Now after 14 years' median follow-up, we reexamined combined hormone therapy effects on lung cancer mortality. PATIENTS AND METHODS: In the WHI placebo-controlled trial, 16,608 postmenopausal women aged 50 to 79 years and with an intact uterus were randomly assigned to once-daily 0.625 mg conjugated equine estrogen plus 2.5 mg medroxyprogesterone acetate (n = 8506) or placebo (n = 8102). Incidence and mortality rates for lung cancer were assessed from multivariant proportional hazard models. RESULTS: After 14 years' cumulative follow-up, there were 219 lung cancers (0.19% per year) in the estrogen plus progestin group and 184 (0.17%) in the placebo group (HR, 1.12; 95% CI, 0.92-1.37; P = .24). While there were more deaths from lung cancer with combined hormone therapy (153 [0.13%] vs. 132 [0.12%], respectively), the difference was not statistically significant (HR, 1.09; 95% CI, 0.87-1.38; P = .45). The statistically significant increase in deaths from lung cancer observed during intervention in women assigned to estrogen plus progestin was attenuated after discontinuation of study pills (linear trend over time, P = .042). CONCLUSION: The increased risk of death from lung cancer observed during estrogen plus progestin use was attenuated after discontinuation of combined hormone therapy.
RCT Entities:
INTRODUCTION: In the Women's Health Initiative (WHI) estrogen plus progestin trial, after 5.6 years' intervention and 8 years' median follow-up, more women died from lung cancer in the hormone therapy group (hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.16-2.52; P = .01). Now after 14 years' median follow-up, we reexamined combined hormone therapy effects on lung cancer mortality. PATIENTS AND METHODS: In the WHI placebo-controlled trial, 16,608 postmenopausal women aged 50 to 79 years and with an intact uterus were randomly assigned to once-daily 0.625 mg conjugated equineestrogen plus 2.5 mg medroxyprogesterone acetate (n = 8506) or placebo (n = 8102). Incidence and mortality rates for lung cancer were assessed from multivariant proportional hazard models. RESULTS: After 14 years' cumulative follow-up, there were 219 lung cancers (0.19% per year) in the estrogen plus progestin group and 184 (0.17%) in the placebo group (HR, 1.12; 95% CI, 0.92-1.37; P = .24). While there were more deaths from lung cancer with combined hormone therapy (153 [0.13%] vs. 132 [0.12%], respectively), the difference was not statistically significant (HR, 1.09; 95% CI, 0.87-1.38; P = .45). The statistically significant increase in deaths from lung cancer observed during intervention in women assigned to estrogen plus progestin was attenuated after discontinuation of study pills (linear trend over time, P = .042). CONCLUSION: The increased risk of death from lung cancer observed during estrogen plus progestin use was attenuated after discontinuation of combined hormone therapy.
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