Endometrial and other cancers

1
Endometrial andother cancers

• David W. Sturdee

2
Unopposed estrogenand endometrial cancer
Year Risk ratio

• Smith 1975 4.5
• Ziel 1975 5.67.6
• Mack 1976 8
• Antunes 1979 615
• Jick 1979 10
• Hammond 1979 3.8
• Weiderpass 1999 6.2

3
HT and risk of endometrial cancerOR (95 CI)

• Duration Sequential Continuous E P combined

lt 5 years 1.5 (1.02.2) 0.8 (0.51.3) gt 5
years 2.9 (1.84.6) 0.2 (0.10.8) Per year 1.1
(1.061.15) 0.86 (0.770.97)
Weiderpass E, et al. J Natl Cancer Inst
199991111317
4
Endometrial hyperplasia rates after1 and 2 years
of low-dose E P

• Womens HOPE Study

Hyperplasia rate ()
0.00
0.00
0.00
0.00
0.00
0.00
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
Womens HOPE, Womens Health, Osteoporosis,
Progestin, Estrogen CEE, conjugated equine
estrogens MPA, medroxyprogesterone acetate
Pickar JH, et al. Fertil Steril 200380123440
5
WHI results effect of HTon risk of colorectal
cancerKaplan-Meier estimate
HR 0.5695 nCI 0.380.8195 aCI 0.330.94
Placebo
EP
Chlebowski RT, et al. N Engl J Med
20043509911004
6
WHI study gynecological cancers (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 0.773.24 Endometrium 27
(0.06) 31 (0.07) 0.81 0.481.36 Cervix 8 (0.02) 5
(0.01) 1.44 0.474.42
Anderson GL, et al. JAMA 2003290173948