Use of hormone replacement therapy before and after ovarian cancer diagnosis and ovarian cancer survival

Abstract

Use of hormone replacement therapy (HRT) has been hypothesized to affect survival of epithelial ovarian cancer (EOC). We studied 5-year survival in patients with invasive EOC and borderline ovarian tumors (BOT) according to HRT use before and after diagnosis in a prospective nation-wide cohort study of 799 women diagnosed with EOC (n 5 649) and BOT (n 5 150) aged 50-74 years in 1993-1995 in Sweden. Cox regression was used to obtain multivariate age-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Multivariate models included indicator variables for age, tumor stage, grade and histological subtype. After 5 years of follow-up, 45% of the patients with EOC and 93% of the patients with BOT were alive. For women with BOT there were no associations between HRT-use pre-or postdiagnosis and survival. There was no overall difference in 5-year EOC survival according to use HRT before diagnosis (multivariate HR 5 0.83, 95% CI 5 0.65-1.08), except for serous EOC (HR 5 0.69, 95% CI 5 0.48-0.98). Analyses of different HRT preparations, duration and recency of use did not reveal any variations in pattern of survival. We observed a better survival for EOC-patients who used HRT after diagnosis (multivariate HR 5 0.57, 95% CI 5 0.42-0.78). We conclude that HRT-use prior to diagnosis of EOC does not affect 5-year survival, except for a possible survival advantage in serous EOC. Women using HRT after diagnosis had a better survival than women with no use, but we cannot rule out that this latter finding may reflect a subtle selection process. ' 2006 Wiley-Liss, Inc.Key words: ovarian cancer; hormonal replacement therapy; survival; mortality; Sweden Hormonal factors are believed to be of fundamental importance in the etiology of ovarian cancer, the 6th most frequent type of female cancer in the world. 1 Ovarian cancer is usually associated with a rather poor prognosis, with overall 5-year survival rates commonly less than 40%. 2 In recent decades in Sweden, HRT has been widely used for relief of climacteric symptoms and to prevent osteoporosis. Progestins without estrogens are mainly used for the treatment of climacteric bleeding irregularities, and for the alleviation of symptoms related to benign appearing ovarian cysts. Estriol can be bought over the counter, and is mostly used for symptomatic treatment of vaginal or urethral atrophy among elderly women. 3,4 While effectively relieving women of climacteric symptoms, use of menopausal hormones has been shown to increase risks of different types of cancer. For breast cancer, there is growing evidence that cyclically combined estrogen-progestin therapy increase risk even more than estrogens alone. 5-8 For endometrial cancer estrogens alone increase risk substantially, as do use of cyclically combined estrogen-progestins. [8][9][10] For epithelial ovarian cancer (EOC) estrogen without progestins, or cyclically combined estrogen-progestins therapy increases risk. 8,11,12 There are few studies on the effects of regimens of estrogens continuously combined to progestins: t...

Hormone therapy and ovarian cancer: incidence and survival

“…However, the finding could reflect an etiologic role of ET in ovarian cancer, a survival disadvantage associated with its use, or both. Mascarenhas and colleagues assessed hormone use both before and after ovarian cancer diagnosis in relation to mortality from ovarian cancer in a Swedish population [22]. Similar to the present data, the authors detected no association between HT use and ovarian cancer mortality regardless of the type of hormone used (E-alone or EP).…”

“…Mascarenhas' study suggests that 15.8% of ovarian cancer cases who had not previously used HT will initiate use and 44.5% of previous users will continue to use HT post-diagnosis. Observational studies have suggested either no association [16,18] or decreased risk [22] in the relationship between HT use after diagnosis and ovarian cancer mortality or recurrence. A randomized-controlled trial of 130 women diagnosed with ovarian cancer aged less than 59 years suggested no association between estrogen therapy and overall mortality or ovarian cancer recurrence [19].…”

“…The latter analyses suggest that HT may be etiologically relevant in ovarian cancer incidence and may also affect mortality. Only one study to date has investigated prediagnosis use of HT in relation to ovarian cancer mortality among ovarian cancer cases and detected no significant association with ever versus never use of HT (HR 0.83, 95% CI 0.65-1.08) [22].…”

Predictors of ovarian cancer survival: A population‐based prospective study in Sweden

“…22 In our current study, the inclusion of the variables of HRT use before or after diagnosis in the statistical models did not alter any of the associations, neither was any significant interaction observed between HRT use before or after diagnosis and each of the above studied factors (data not shown).…”

“…[10][11][12][13][14][15] While clinical characteristics of the tumor have been shown to be strongly related to survival among patients with ovarian cancer, [16][17][18][19] little is known about the prognostic role of reproductive history, lifestyle factors and family history of cancer. [20][21][22][23][24][25][26][27] Recent studies suggest that young age at menarche, 28 overweight or obesity before diagnosis 21,25,29 and history of smoking before diagnosis 21,30 affect ovarian cancer survival negatively. Evidence from studies on another hormone-related cancer, breast cancer, also suggests that reproductive history and life-style factors before diagnosis, such as obesity, physical activity and smoking influence disease prognosis.…”