Johanna Simin1, Rulla Tamimi2, Jesper Lagergren3, Hans-Olov Adami4, Nele Brusselaers5. 1. Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research (CTMR), Karolinska Institutet, Nobels Väg 16, SE-171 77 Stockholm, Sweden; Science for Life Laboratory (SciLifeLab), SE-171 21 Stockholm, Sweden. 2. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA. 3. Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Division of Cancer Studies, King's College London and Guy's and St Thomas' NHS Foundation Trust, United Kingdom. 4. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway. 5. Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research (CTMR), Karolinska Institutet, Nobels Väg 16, SE-171 77 Stockholm, Sweden; Science for Life Laboratory (SciLifeLab), SE-171 21 Stockholm, Sweden. Electronic address: nele.brusselaers@ki.se.
Abstract
AIM: We aimed to assess the overall cancer risk among contemporary menopausal hormone therapy (MHT) users in Sweden and the risk for different cancer types. METHODS: A nationwide Swedish population-based cohort study including all 290,186 women aged ≥ 40 years having used systemic MHT during the study period (July 2005 and December 2012), compared with the Swedish female background population. MHT ever-use (all MHT, oestrogen-only MHT [E-MHT] and oestrogen plus progestin MHT [EP-MHT]) was based on the nationwide Prescribed Drug Registry. Cancer diagnoses were grouped into 16 different anatomical locations, for which standardised incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated. RESULTS: The SIR of any cancer was 1.09 (95% CI: 1.07-1.11) following ever MHT, 1.04 (95% CI: 1.01-1.06) for E-MHT and 1.14 (95% CI: 1.12-1.17) for EP-MHT. The highest SIR was found for EP-MHT among users aged ≥70 years (SIR = 1.33, 95% CI: 1.26-1.40). The risk for invasive breast, endometrial or ovarian cancer combined was increased for any MHT (SIR = 1.31, 95% CI: 1.28-1.34). The risk of invasive breast cancer was increased following MHT and increased with age for EP-MHT users. The risk of gastrointestinal cancers combined was decreased (SIR = 0.90, 95% CI: 0.86-0.94), particularly the oesophagus (SIR = 0.81, 95% CI: 0.64-1.00), liver (SIR = 0.81, 95% CI: 0.65-0.99) and colon (SIR = 0.90, 95% CI: 0.84-0.95). CONCLUSIONS: MHT, notably EP-MHT, was associated with a limited increase in overall cancer risk. The increased risk of female reproductive organ cancers was almost balanced by a decreased risk of gastrointestinal cancers.
AIM: We aimed to assess the overall cancer risk among contemporary menopausal hormone therapy (MHT) users in Sweden and the risk for different cancer types. METHODS: A nationwide Swedish population-based cohort study including all 290,186 women aged ≥ 40 years having used systemic MHT during the study period (July 2005 and December 2012), compared with the Swedish female background population. MHT ever-use (all MHT, oestrogen-only MHT [E-MHT] and oestrogen plus progestin MHT [EP-MHT]) was based on the nationwide Prescribed Drug Registry. Cancer diagnoses were grouped into 16 different anatomical locations, for which standardised incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated. RESULTS: The SIR of any cancer was 1.09 (95% CI: 1.07-1.11) following ever MHT, 1.04 (95% CI: 1.01-1.06) for E-MHT and 1.14 (95% CI: 1.12-1.17) for EP-MHT. The highest SIR was found for EP-MHT among users aged ≥70 years (SIR = 1.33, 95% CI: 1.26-1.40). The risk for invasive breast, endometrial or ovarian cancer combined was increased for any MHT (SIR = 1.31, 95% CI: 1.28-1.34). The risk of invasive breast cancer was increased following MHT and increased with age for EP-MHT users. The risk of gastrointestinal cancers combined was decreased (SIR = 0.90, 95% CI: 0.86-0.94), particularly the oesophagus (SIR = 0.81, 95% CI: 0.64-1.00), liver (SIR = 0.81, 95% CI: 0.65-0.99) and colon (SIR = 0.90, 95% CI: 0.84-0.95). CONCLUSIONS: MHT, notably EP-MHT, was associated with a limited increase in overall cancer risk. The increased risk of female reproductive organ cancers was almost balanced by a decreased risk of gastrointestinal cancers.
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