HRT and Lung Cancer Risk
News is out from The Lancet that the link between HRT (as in estrogen/progestin) and lung cancer poses an unacceptable risk to women. Sources such as the Guardian and the Washington Post report on new results from the WHI:
after the 8 years total follow-up, more women died from lung cancer in the combined hormone therapy group than in the placebo group (73 vs 40 deaths; women in HRT group 71% more likely to die). This was mainly as a result of a higher number of deaths from non-small-cell lung cancer (NSCLC) in the combined therapy group (62 vs 31 deaths; women in HRT group 87% more likely to die specifically of NSCLC).
We’ve already read that removal of ovaries has been linked to increased death from lung cancer and now we are reading that HRT itself is also linked.
But what is really making the news is that Apar Kishor Ganti of the University of Nebraska Medical Center in Omaha, Nebraska, has extrapolated findings to ” seriously question whether hormone-replacement therapy has any role in medicine today”.
Certainly a controversial statement but is it at all warranted?
Not according to The International Menopause Society. In their response to The Lancet paper they noted that age was a key factor in the report findings. In fact in the age group 50–59 years, the numbers of deaths from lung cancers were almost identical for the HRT and placebo groups.
They state:
The International Menopause Society agrees with the WHI that older women who are at high risk should take care in starting HRT. However, our advice is that HRT can be prescribed without any increased risk of lung cancer death in the 50–59-year age group. This is exactly what the Chlebowski paper says, although it is unclear to us why this has not been brought out in the comment or press release, and why it is not highlighted in the paper. The relevance of age and years since menopause at the initiation of HT is recognized as a major determinant of the risks associated with HT and, therefore, it is imperative to address this issue in any WHI database analysis.
The Australian Hean Hailes Foundation has also provided opinion on this study stating:
It is of no significance for healthy women taking HRT in their 50s at the time of menopause for 2-5 years for the relief of menopausal symptoms. For women over 60 years on longer term treatment, who have a higher risk of lung cancer (current or ex-smokers), the findings need to be included in the risk to benefit considerations when regularly reviewing the advisability of HRT continuation or not.
There is no indication from this study for stopping HRT used for symptom relief in younger healthy women in their 50s.
For otherwise healthy women under 60 years of age taking combined oestrogen and progestin therapy there is no evidence of increased lung cancer risk or of increased death from lung cancer. Even in those older than 60 there was no evidence or proof of increased risk, only a suggestion more cases occurred in HRT users. For those over 60 years this inconclusive data suggests that there is a 3 in 10,000 increased risk of lung cancer per year in HRT users compared to nonusers. There is a small increased risk of dying from lung cancer in those on HRT compared to non HRT users of around 5 per 10,000 per year.