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February 25, 2015
Even Short-Term HRT Use Raises Ovarian Cancer
Risk in Women Oxford, England—Using hormone replacement therapy (HRT) to relieve menopause symptoms, even for a few years, can significantly increase a woman’s risk of developing the two most common types of ovarian cancer, according to a detailed re-analysis of all available evidence. Results of the meta-analysis of 52 epidemiological studies were published recently in The Lancet. The reviewed studies involved 21,488 women with ovarian cancer, almost all from North America, Europe, and Australia, and indicated that women on HRT therapy for just a few years are about 40% more likely to develop ovarian cancer than women who have never used it. “For women who take HRT for five years from around age 50, there will be about one extra ovarian cancer for every 1000 users and one extra ovarian cancer death for every 1700 users,” explained co-author Sir Richard Peto, professor at the University of Oxford in the UK. HRT use fell rapidly after a 2002 Women’s Health Initiative study found that taking estrogen plus progestin HRT increased a woman's risk of heart disease and breast cancer. The decrease has since leveled off, and, in the United Kingdom and the United States combined, about 6 million women still are still taking HRT, according to the report. Existing treatment guidelines on HRT generally do not mention the threat of ovarian cancer or, if they do, suggest that it is only a danger with long-term use, the authors note. They add that previous studies were too small to reliably assess the risks from just a few years of HRT use. For this meta-analysis, individual participant data from 52 studies, essentially all of the epidemiological evidence available on the link between HRT use and ovarian cancer, were analyzed by the Collaborative Group on Epidemiological Studies of Ovarian Cancer, organized by the University of Oxford and involving over 100 researchers worldwide. Results indicate a substantially increased risk of developing ovarian cancer in current or recent users—those using HRT within the previous 5 years. The risk of ovarian cancer fell after treatment discontinuation, but women who had used HRT for at least 5 years still had a somewhat increased risk of ovarian cancer a decade later, according to the findings. The risk of developing ovarian cancer didn’t differ by types of HRT—estrogen only or estrogen combined with progestogen. In addition, the proportional increase in risk was not substantively affected by the age of HRT initiation, body size, past use of oral contraceptives, hysterectomy, alcohol use, tobacco use, or family history of breast or ovarian cancer. An increase in risk was seen only for the two most common types of ovarian cancer, serous and endometrioid ovarian cancers, and not for the two less common types—mucinous and clear cell, the authors write. “The definite risk of ovarian cancer even with less than five years of HRT is directly relevant to today's patterns of use—with most women now taking HRT for only a few years—and has implications for current efforts to revise UK and worldwide guidelines,” suggested study co-author Dame Valerie Beral, also a professor at the University of Oxford.
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