Lancet. 2009 Oct 10;374(9697):1243-51. Epub 2009 Sep 18.
Oestrogen plus progestin and lung cancer in postmenopausal women (Women's Health Initiative trial): a post-hoc analysis of a randomised controlled trial.
Chlebowski RT,
Schwartz AG,
Wakelee H,
Anderson GL,
Stefanick ML,
Manson JE,
Rodabough RJ,
Chien JW,
Wactawski-Wende J,
Gass M,
Kotchen JM,
Johnson KC,
O'Sullivan MJ,
Ockene JK,
Chen C,
Hubbell FA;
Women's Health Initiative Investigators.
Nabel E, Rossouw J, Ludlam S, McGowan J, Geller N, Ford L, Prentice R, Anderson G, LaCroix A, Patterson R, McTiernan A, Cochrane B, Hunt J, Tinker L, Kooperberg C, McIntosh M, Wang CY, Chen C, Bowen D, Kristal A, Stanford J, Urban N, Weiss N, White E, Stein E, Laskarzewski P, Cummings SR, Nevitt M, Palermo L, Harnack L, Cammarata F, Lindenfelser S, Psaty B, Heckbert S, Wassertheil-Smoller S, Frishman W, Wylie-Rosett J, Barad D, Freeman R, Rajkovic A, Hays J, Young R, Sangi-Haghpeykar H, Manson JE, Rexrode KM, Walsh B, Gaziano JM, Bueche M, Eaton CB, Cyr M, Sloane G, Phillips L, Butler V, Porter V, Beresford SA, Taylor VM, Woods NF, Henderson M, Andersen R, Martin L, Hsia J, Gaba N, Katz R, Chlebowski R, Detrano R, Nelson A, Geller M, Michael Y, Whitlock E, Stevens V, Karanja N, Caan B, Sidney S, Bailey G, Hirata J, Kotchen JM, Barnabei V, Kotchen TA, Gilligan MA, Neuner J, Howard BV, Adams-Campbell L, Lessin L, Iglesia C, Mickel LK, Van Horn L, Greenland P, Khandekar J, Liu K, Rosenberg C, Black H, Powell L, Mason E, Gulati M, Stefanick ML, Hlatky MA, Chen B, Stafford RS, Mackey S, Lane D, Granek I, Lawson W, Messina C, San Roman G, Jackson R, Harris R, Paskett E, Mysiw WJ, Blumenfeld M, Lewis CE, Oberman A, Shikany JM, Safford M, Thomson CA, Bassford T, Ritenbaugh C, Chen Z, Ko M, Wactawski-Wende J, Trevisan M, Smit E, Graham S, Chang J, Robbins J, Yasmeen S, Hubbell FA, Frank G, Wong N, Greep N, Monk B, Nathan L, Heber D, Elashoff R, Liu S, Langer RD, Criqui MH, Talavera GT, Garland CF, Allison MA, Gass M, Watts N, Limacher M, Perri M, Kaunitz A, Williams RS, Brinson Y, Curb JD, Petrovitch H, Rodriguez B, Masaki K, Blanchette P, Wallace R, Torner J, Johnson S, Snetselaar L, Robinson J, Ockene J, Rosal M, Ockene I, Yood R, Aronson P, Lasser N, Singh B, Lasser V, Kostis J, McGovern P, O'Sullivan MJ, Parker L, Potter J, Fernandez D, Caralis P, Margolis KL, Grimm RH, Perron MF, Bjerk C, Kempainen S, Brunner R, Graettinger W, Oujevolk V, Bloch M, Heiss G, Haines P, Ontjes D, Sueta C, Wells E, Kuller L, Cauley J, Milas NC, Johnson KC, Satterfield S, Li R, Connelly S, Tylavsky F, Brzyski R, Schenken R, Sarto GE, Laube D, McBride P, Mares J, Loevinger B, Vitolins M, Burke G, Crouse R, Washburn S, Simon M, Hays J, Foreyt F, Assaf AR, Hall D, Miller V, Valanis B, Hiatt R, Clifford C, Pottern L, Meyskens F Jr, Judd H, Liu J, Watts N, Baum M, Grimm R, Daugherty S, Sheps D, Hulka B, Applegate W, Allen C, Bonds D.
Source
Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA. rchlebowski@gmail.com
Abstract
BACKGROUND:
In the post-intervention period of the Women's Health Initiative (WHI) trial, women assigned to treatment with oestrogen plus progestin had a higher risk of cancer than did those assigned to placebo. Results also suggested that the combined hormone therapy might increase mortality from lung cancer. To assess whether such an association exists, we undertook a post-hoc analysis of lung cancers diagnosed in the trial over the entire follow-up period.
METHODS:
The WHI study was a randomised, double-blind, placebo-controlled trial undertaken in 40 centres in the USA. 16 608 postmenopausal women aged 50-79 years with an intact uterus were randomly assigned by a computerised, stratified, permuted block algorithm to receive a once-daily tablet of 0.625 mg conjugated equine oestrogen plus 2.5 mg medroxyprogesterone acetate (n=8506) or matching placebo (n=8102). We assessed incidence and mortality rates for all lung cancer, small-cell lung cancer, and non-small-cell lung cancer by use of data from treatment and post-intervention follow-up periods. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00000611.
FINDINGS:
After a mean of 5.6 years (SD 1.3) of treatment and 2.4 years (0.4) of additional follow-up, 109 women in the combined hormone therapy group had been diagnosed with lung cancer compared with 85 in the placebo group (incidence per year 0.16%vs 0.13%; hazard ratio [HR] 1.23, 95% CI 0.92-1.63, p=0.16). 96 women assigned to combined therapy had non-small-cell lung cancer compared with 72 assigned to placebo (0.14%vs 0.11%; HR 1.28, 0.94-1.73, p=0.12). More women died from lung cancer in the combined hormone therapy group than in the placebo group (73 vs 40 deaths; 0.11%vs 0.06%; HR 1.71, 1.16-2.52, p=0.01), mainly as a result of a higher number of deaths from non-small-cell lung cancer in the combined therapy group (62 vs 31 deaths; 0.09%vs 0.05%; HR 1.87, 1.22-2.88, p=0.004). Incidence and mortality rates of small-cell lung cancer were similar between groups.
INTERPRETATION:
Although treatment with oestrogen plus progestin in postmenopausal women did not increase incidence of lung cancer, it increased the number of deaths from lung cancer, in particular deaths from non-small-cell lung cancer. These findings should be incorporated into risk-benefit discussions with women considering combined hormone therapy, especially those with a high risk of lung cancer.
FUNDING:
National Heart, Lung and Blood Institute, National Institutes of Health.
- PMID:
- 19767090
- [PubMed - indexed for MEDLINE]
- PMCID:
- PMC2995490
Free PMC ArticleFigure 1
Kaplan-Meier cumulative hazards for incidence from lung cancer by category, randomization group and by time in the trial. Hazard ratios (HR), 95% confidence interval (CI), and P-values are from Cox proportional hazards regression models, stratified by age and dietary modification randomization group.
Lancet. 2009 October 10;374(9697):1243-1251.
Figure 2
Kaplan-Meier cumulative hazard for death from lung cancer by category, randomization group and time in the trial. Hazard ratios (HR), 95% confidence interval (CI), and P-values are from Cox proportional hazards regression models, stratified by age and dietary modification randomization group.
Lancet. 2009 October 10;374(9697):1243-1251.
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