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.

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


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.

© The Author(s), under exclusive licence to Springer Nature Limited 2021

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