Endometrial andEndometrial andother cancersother cancers

David W. Sturdee

Unopposed estrogenUnopposed estrogenand endometrial cancerand endometrial cancer

Smith 1975 4.5

Ziel 1975 5.6–7.6

Mack 1976 8

Antunes 1979 6–15

Jick 1979 10

Hammond 1979 3.8

Weiderpass 1999 6.2

Year Risk ratio

< 5 years 1.5 (1.0–2.2) 0.8 (0.5–1.3)

> 5 years 2.9 (1.8–4.6) 0.2 (0.1–0.8)

Per year 1.1 (1.06–1.15) 0.86 (0.77–0.97)

Duration Sequential Continuous E + P combined

HT and risk of endometrial cancerHT and risk of endometrial cancerOR (95% CI)OR (95% CI)

Weiderpass E, et al. J Natl Cancer Inst 1999;911:1131–7

Women’s HOPE, Women’s Health, Osteoporosis, Progestin, Estrogen; CEE, conjugated equine estrogens; MPA, medroxyprogesterone acetate

Endometrial hyperplasia rates afterEndometrial hyperplasia rates after1 and 2 years of low-dose E + P1 and 2 years of low-dose E + P

Women’s HOPE Study

0

5

10

15

20

25

30

Hyp

erp

lasi

a ra

te (

%)

0.625 mg 0.625/2.5 mg

0.45 mg 0.45/2.5 mg

0.45/1.5 mg

0.3 mg 0.3/1.5 mg

Placebo

CEE CEE/MPA

0.000.000.000.000.000.00

Year 1

Year 2

Pickar JH, et al. Fertil Steril 2003;80:1234–40

Chlebowski RT, et al. N Engl J Med 2004;350:991–1004

0.000

0.005

0.010

0.015

0 1 2 3 4 5 6 7

Time (years)

Cu

mu

lati

ve

ha

zard

fo

r c

olo

rec

tal c

an

ce

r

WHI results: effect of HTWHI results: effect of HTon risk of colorectal canceron risk of colorectal cancer

Kaplan-Meier estimateHR = 0.5695% nCI = 0.38–0.8195% aCI = 0.33–0.94 Placebo

E+P

WHI study: gynecological cancers WHI study: gynecological cancers (annualized %)(annualized %)

CEE + Hazard 95% Outcome MPA Placebo ratio nCI

n 8506 8102

Duration (months) 67.8 66.8

Ovary 20 (0.04) 12 (0.03) 1.58 0.77–3.24

Endometrium 27 (0.06) 31 (0.07) 0.81 0.48–1.36

Cervix 8 (0.02) 5 (0.01) 1.44 0.47–4.42

Anderson GL, et al. JAMA 2003;290:1739–48