Hormone therapy and esophageal adenocarcinoma

Drs. Xie and colleagues observed a decreased risk of esophageal adenocarcinoma among women taking post-menopausal hormones in this population-based cohort study in Sweden with 693 EAC cases. This supports the concept that female sex hormones contribute to the lower incidence of EAC in women.

Tom Vaughan

13 Apr 2022 — 1 min read

British Journal of Cancer; https://doi.org/10.1038/s41416-021-01575-8

Menopausal hormone therapy and risk of oesophageal adenocarcinoma in a population-based cohort study

Shao-Hua Xie, Giola Santoni, and Jesper Lagergren

Abstract

BACKGROUND: Oesophageal adenocarcinoma is characterised by a strong male predominance. We aimed to test the hypothesis that menopausal hormonal therapy decreases the risk of oesophageal adenocarcinoma.

METHODS: This population-based cohort study included all women who used systemic menopausal hormonal therapy (exposed) in Sweden between 2005 and 2018. For each exposed participant, five randomly selected female age-matched non-users of menopausal hormonal therapy (unexposed) were included. Cox regression provided hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age, smoking-related diagnoses, Helicobacter pylori eradication, use of non-steroidal anti-inflammatory drugs/aspirin, use of statins and hysterectomy.

RESULTS: The study included 296,964 users of menopausal hormonal therapy and 1,484,820 non-users. Ever-users of menopausal hormonal therapy had an overall decreased risk of oesophageal adenocarcinoma (HR 0.78, 95% CI 0.63–0.97), which remained unchanged after further adjustment for gastro-oesophageal reflux disease (HR 0.78, 95% CI 0.63–0.97) and obesity/diabetes (HR 0.79, 95% CI 0.63–0.98). Decreased HRs were indicated both in users of oestrogen only (HR 0.82, 95% CI 0.60–1.12) and oestrogen combined with progestogen (HR 0.75, 95% CI 0.56–1.00). The risk reduction was more pronounced in users younger than 60 years (HR 0.57, 95% CI 0.38–0.86).

CONCLUSIONS: Menopausal hormone therapy in women may decrease the risk of oesophageal adenocarcinoma.

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