Hormone replacement therapy and cancer mortality in women with 17 site-specific cancers: a cohort study using linked medical records

Cardwell, Chris R.; Ranger, Tom A.; Labeit, Alexander M.; Coupland, Carol A. C.; Hicks, Blánaid; Hughes, Carmel; McMenamin, Úna; Mei, Xue W.; Murchie, Peter; Hippisley-Cox, Julia

Abstract

Background: There is limited evidence on the safety of Hormone Replacement Therapy (HRT) in women with cancer. Therefore, we systematically examined HRT use and cancer-specific mortality in women with 17 site-specific cancers. Methods: Women newly diagnosed with 17 site-specific cancers from 1998 to 2019, were identified from general practitioner (GP) records, hospital diagnoses or cancer registries in Scotland, Wales and England. Breast cancer patients were excluded because HRT is contraindicated in breast cancer patients. The primary outcome was time to cancer-specific mortality. Time-dependent Cox regression models were used to calculate adjusted hazard ratios (HR) and 95% confidence intervals (95% CIs) for cancer-specific mortality by systemic HRT use. Results: The combined cancer cohorts contained 182,589 women across 17 cancer sites. Overall 7% of patients used systemic HRT after their cancer diagnosis. There was no evidence that HRT users, compared with non-users, had higher cancer-specific mortality at any cancer site. In particular, no increase was observed in common cancers including lung (adjusted HR = 0.98 95% CI 0.90, 1.07), colorectal (adjusted HR = 0.79 95% CI 0.70, 0.90), and melanoma (adjusted HR = 0.77 95% CI 0.58, 1.02). Conclusions: We observed no evidence of increased cancer-specific mortality in women with a range of cancers (excluding breast) receiving HRT.

Citation

Cardwell, C. R., Ranger, T. A., Labeit, A. M., Coupland, C. A. C., Hicks, B., Hughes, C., McMenamin, Ú., Mei, X. W., Murchie, P., & Hippisley-Cox, J. (in press). Hormone replacement therapy and cancer mortality in women with 17 site-specific cancers: a cohort study using linked medical records. British Journal of Cancer, https://doi.org/10.1038/s41416-024-02767-8

• Journal Article Type: Article
• Acceptance Date: Jun 14, 2024
• Online Publication Date: Jun 24, 2024
• Deposit Date: Jun 28, 2024
• Publicly Available Date: Jun 28, 2024
• Journal: British Journal of Cancer
• Print ISSN: 0007-0920
• Electronic ISSN: 1532-1827
• Publisher: Cancer Research UK
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1038/s41416-024-02767-8
• Keywords: Cancer epidemiology; Hormonal therapies
• Public URL: https://nottingham-repository.worktribe.com/output/36576009
• Additional Information: Received: 21 February 2024; Revised: 11 June 2024; Accepted: 14 June 2024; First Online: 24 June 2024; : JHC is an unpaid director of QResearch, a not-for-profit organisation which is a partnership between the University of Oxford and EMIS Health who supply the QResearch database used for this work. JHC has a 50% shareholding in ClinRisk Ltd, co-owning it with her husband, who is a director. As a shareholder and spouse of a director she has a financial and family interest in the ongoing and future success of the company. The company licences software both to the private sector and to NHS bodies or bodies that provide services to the NHS (through GP electronic health record providers, pharmacies, hospital providers and other NHS providers). This software implements algorithms (outside the scope of this research) developed from access to the QResearch database during her time at the University of Nottingham. The other authors have declared no competing interests.; : Approval for analysis of the Welsh data has been obtained from the SAIL Databank Information Governance Review Panel (Reference: 0965) and approval for the analysis of the Scottish data has been obtained from the Public Benefit and Privacy Panel for Health and Social Care (Reference: 2021–0014). In both Scotland and Wales only de-identified data was used and therefore written informed consent was not obtained. Approval for the analysis of the English data was obtained from the QResearch scientific committee (Project ref: OX24, title ‘Use of hormone replacement therapy and survival from cancer’). Ethical approval for the QResearch database is obtained annually from East Midlands—Derby Research Ethics Committee (Ref: 18/EM/0400).