Safety of hormone replacement therapy in women with a history of cervical adenocarcinoma

Abstract

Objectives Studies investigating the safety of hormone replacement therapy in cervical cancer have predominantly included patients with squamous disease. Pathological studies have identified estrogen receptor positivity in cervical adenocarcinomas. A recent small case-control study suggested a trend towards reduced survival with hormone replacement therapy in cervical adenocarcinomas. Our objective was to determine if hormone replacement therapy use in patients treated for cervical adenocarcinomas is detrimental to survival. Study design A retrospective review of all women under the age of 50 with stage 1B-2B cervical adenocarcinomas diagnosed between 1 November 2000 and 24 September 2019. Women were categorised into three groups: ovaries conserved (OVCON); or iatrogenic menopause with (IM-HRT) or without (IM-NOHRT) hormone replacement therapy. Hormone replacement therapy use was defined on an intention to treat basis. Statistical analysis was performed using Kaplan-Meier and Cox proportional hazards methods. Main outcome measures Overall (OS), disease specific (DSS) and progression free (PFS) survival. Results A total of 58 women (mean age 38.5 ± 6.6) were included in the study of whom 25 (43.1%) had OVCON, 20 (34.4%) had IM-HRT and 13 (22.4%) had IM-NOHRT. No menopause-associated deaths occurred. Although five-year DSS was 73% in IM-NOHRT compared to 95% in IM-HRT and 95% in OVCON, these differences were not statistically significant. Five-year PFS was 68% in IM-NOHRT compared to 90% in IM-HRT and 81% in OVCON but again, these differences were not statistically significant. Conclusion In this small study, hormone replacement therapy does not appear to be detrimental to survival in cervical adenocarcinomas. There is a trend towards improved survival with hormone replacement therapy. Larger studies are required to substantiate these findings.

Individual Benefits and Risks of Intravaginal Estrogen and Systemic Testosterone in the Management of Women in the Menopause, With a Discussion of Any Associated Risks for Cancer Development

“…A recent retrospective cohort study of 244 women who received vaginal estrogen found no increased risk of cervical cancer recurrence, and in this study, 40.3% of the cervical cancer cohort had prior adenocarcinoma 71 . Furthermore, in a very recent small retrospective study of women younger than 50 years with stage 1B–2B cervical adenocarcinomas, there was a trend toward improved survival rates with hormone replacement therapy 75 …”

“…71 Furthermore, in a very recent small retrospective study of women younger than 50 years with stage 1B-2B cervical adenocarcinomas, there was a trend toward improved survival rates with hormone replacement therapy. 75…”

Hormone Replacement Therapy in Post-Menopause Hormone-Dependent Gynecological Cancer Patients: A Narrative Review

“…A recent retrospective review evaluating the safety of HRT specifically in AC patients was published in 2021 [ 60 ]. In this review, all women with stage 1B–2B AC under the age of 50 were enrolled.…”

A retrospective audit of general practitioner’s referrals to Guys and St Thomas’ specialist menopause clinic between 2021 and 2022

“…Most cervical cancers are squamous cell carcinoma so they are non-estrogen dependent. 12 A systematic review conducted in 2021 of the PubMed English literature determined HRT had no detrimental effect on cervical cancer oncological outcomes, while several benefits were demonstrated, including reduced metabolic risk and improved quality of life, suggesting HRT should be offered to young cervical cancer survivors for early menopause management. 12 , 13 Providing clear guidance to GPs and GP champions in menopause for managing menopausal women with a personal history of gynaecological cancer through training and conferences would help reduce the delay in treating affected women.…”