Estrogen and colorectal cancer incidence and mortality

Sayeh Lavasani, Rowan T. Chlebowski, Ross L. Prentice, Ikuko Kato, Jean Wactawski-Wende, Karen Johnson, Alicia Young, Rebecca Rodabough, F. Allan Hubbell, Ali Mahinbakht, Michael S. Simon

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Abstract

BACKGROUND: The preponderance of observational studies describe an association between the use of estrogen alone and a lower incidence of colorectal cancer. In contrast, no difference in the incidence of colorectal cancer was seen in the Women's Health Initiative (WHI) randomized, placebo-controlled trial with estrogen alone after a mean intervention of 7.1 years and cumulative follow-up of 13.2 years. This study extends these findings by providing detailed analyses of the effects of estrogen alone on the histology, grade, and stage of colorectal cancer, relevant subgroups, and deaths from and after colorectal cancer. METHODS: The WHI study was a randomized, double-blind, placebo-controlled trial involving 10,739 postmenopausal women with prior hysterectomy. Participants were assigned to conjugated equine estrogen at 0.625 mg/d (n = 5279) or a matching placebo (n = 5409). Rates of colorectal cancer diagnoses and deaths from and after colorectal cancer were assessed throughout the study. RESULTS: Colorectal cancer rates in the estrogen-alone and placebo groups were comparable: 0.14% and 0.12% per year, respectively (hazard ratio [HR], 1.13; 95% confidence interval [CI], 0.83-1.58; P = .43). Bowel screening examinations were comparable between the 2 groups throughout the study. The grade, stage, and location of colorectal cancer did not differ between the randomization groups. There were more colorectal cancer deaths in the estrogen-alone group (34 [0.05%] vs 24 [0.03%]; HR, 1.46, 95% CI, 0.86-2.46; P = .16), but the difference was not statistically significant. The colorectal cancer incidence was higher for participants with a history of colon polyp removal in the estrogen-alone group (0.23% vs 0.02%; HR, 13.47; nominal 95% CI, 1.76-103.0; P < .001). CONCLUSIONS: The use of estrogen alone in postmenopausal women with prior hysterectomy does not influence the incidence of colorectal cancer or deaths from or after colorectal cancer. A possibly higher risk of colorectal cancer in women with prior colon polyp removal who use estrogen alone requires confirmation.

Original languageEnglish (US)
Pages (from-to)3261-3271
Number of pages11
JournalCancer
Volume121
Issue number18
DOIs
StatePublished - Sep 1 2015

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Colorectal Neoplasms
Estrogens
Mortality
Incidence
Placebos
Women's Health
Confidence Intervals
Polyps
Hysterectomy
Colon
Conjugated (USP) Estrogens
Random Allocation
Observational Studies
Histology
Randomized Controlled Trials

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Lavasani, S., Chlebowski, R. T., Prentice, R. L., Kato, I., Wactawski-Wende, J., Johnson, K., ... Simon, M. S. (2015). Estrogen and colorectal cancer incidence and mortality. Cancer, 121(18), 3261-3271. https://doi.org/10.1002/cncr.29464

Estrogen and colorectal cancer incidence and mortality. / Lavasani, Sayeh; Chlebowski, Rowan T.; Prentice, Ross L.; Kato, Ikuko; Wactawski-Wende, Jean; Johnson, Karen; Young, Alicia; Rodabough, Rebecca; Hubbell, F. Allan; Mahinbakht, Ali; Simon, Michael S.

In: Cancer, Vol. 121, No. 18, 01.09.2015, p. 3261-3271.

Research output: Contribution to journalArticle

Lavasani, S, Chlebowski, RT, Prentice, RL, Kato, I, Wactawski-Wende, J, Johnson, K, Young, A, Rodabough, R, Hubbell, FA, Mahinbakht, A & Simon, MS 2015, 'Estrogen and colorectal cancer incidence and mortality', Cancer, vol. 121, no. 18, pp. 3261-3271. https://doi.org/10.1002/cncr.29464
Lavasani S, Chlebowski RT, Prentice RL, Kato I, Wactawski-Wende J, Johnson K et al. Estrogen and colorectal cancer incidence and mortality. Cancer. 2015 Sep 1;121(18):3261-3271. https://doi.org/10.1002/cncr.29464
Lavasani, Sayeh ; Chlebowski, Rowan T. ; Prentice, Ross L. ; Kato, Ikuko ; Wactawski-Wende, Jean ; Johnson, Karen ; Young, Alicia ; Rodabough, Rebecca ; Hubbell, F. Allan ; Mahinbakht, Ali ; Simon, Michael S. / Estrogen and colorectal cancer incidence and mortality. In: Cancer. 2015 ; Vol. 121, No. 18. pp. 3261-3271.
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abstract = "BACKGROUND: The preponderance of observational studies describe an association between the use of estrogen alone and a lower incidence of colorectal cancer. In contrast, no difference in the incidence of colorectal cancer was seen in the Women's Health Initiative (WHI) randomized, placebo-controlled trial with estrogen alone after a mean intervention of 7.1 years and cumulative follow-up of 13.2 years. This study extends these findings by providing detailed analyses of the effects of estrogen alone on the histology, grade, and stage of colorectal cancer, relevant subgroups, and deaths from and after colorectal cancer. METHODS: The WHI study was a randomized, double-blind, placebo-controlled trial involving 10,739 postmenopausal women with prior hysterectomy. Participants were assigned to conjugated equine estrogen at 0.625 mg/d (n = 5279) or a matching placebo (n = 5409). Rates of colorectal cancer diagnoses and deaths from and after colorectal cancer were assessed throughout the study. RESULTS: Colorectal cancer rates in the estrogen-alone and placebo groups were comparable: 0.14{\%} and 0.12{\%} per year, respectively (hazard ratio [HR], 1.13; 95{\%} confidence interval [CI], 0.83-1.58; P = .43). Bowel screening examinations were comparable between the 2 groups throughout the study. The grade, stage, and location of colorectal cancer did not differ between the randomization groups. There were more colorectal cancer deaths in the estrogen-alone group (34 [0.05{\%}] vs 24 [0.03{\%}]; HR, 1.46, 95{\%} CI, 0.86-2.46; P = .16), but the difference was not statistically significant. The colorectal cancer incidence was higher for participants with a history of colon polyp removal in the estrogen-alone group (0.23{\%} vs 0.02{\%}; HR, 13.47; nominal 95{\%} CI, 1.76-103.0; P < .001). CONCLUSIONS: The use of estrogen alone in postmenopausal women with prior hysterectomy does not influence the incidence of colorectal cancer or deaths from or after colorectal cancer. A possibly higher risk of colorectal cancer in women with prior colon polyp removal who use estrogen alone requires confirmation.",
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AU - Lavasani, Sayeh

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AU - Prentice, Ross L.

AU - Kato, Ikuko

AU - Wactawski-Wende, Jean

AU - Johnson, Karen

AU - Young, Alicia

AU - Rodabough, Rebecca

AU - Hubbell, F. Allan

AU - Mahinbakht, Ali

AU - Simon, Michael S.

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N2 - BACKGROUND: The preponderance of observational studies describe an association between the use of estrogen alone and a lower incidence of colorectal cancer. In contrast, no difference in the incidence of colorectal cancer was seen in the Women's Health Initiative (WHI) randomized, placebo-controlled trial with estrogen alone after a mean intervention of 7.1 years and cumulative follow-up of 13.2 years. This study extends these findings by providing detailed analyses of the effects of estrogen alone on the histology, grade, and stage of colorectal cancer, relevant subgroups, and deaths from and after colorectal cancer. METHODS: The WHI study was a randomized, double-blind, placebo-controlled trial involving 10,739 postmenopausal women with prior hysterectomy. Participants were assigned to conjugated equine estrogen at 0.625 mg/d (n = 5279) or a matching placebo (n = 5409). Rates of colorectal cancer diagnoses and deaths from and after colorectal cancer were assessed throughout the study. RESULTS: Colorectal cancer rates in the estrogen-alone and placebo groups were comparable: 0.14% and 0.12% per year, respectively (hazard ratio [HR], 1.13; 95% confidence interval [CI], 0.83-1.58; P = .43). Bowel screening examinations were comparable between the 2 groups throughout the study. The grade, stage, and location of colorectal cancer did not differ between the randomization groups. There were more colorectal cancer deaths in the estrogen-alone group (34 [0.05%] vs 24 [0.03%]; HR, 1.46, 95% CI, 0.86-2.46; P = .16), but the difference was not statistically significant. The colorectal cancer incidence was higher for participants with a history of colon polyp removal in the estrogen-alone group (0.23% vs 0.02%; HR, 13.47; nominal 95% CI, 1.76-103.0; P < .001). CONCLUSIONS: The use of estrogen alone in postmenopausal women with prior hysterectomy does not influence the incidence of colorectal cancer or deaths from or after colorectal cancer. A possibly higher risk of colorectal cancer in women with prior colon polyp removal who use estrogen alone requires confirmation.

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