Menopausal Hormone therapy Linked to Reduced risk of Esophageal and Gastric Cancers
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A new, large-scale study suggests menopausal hormone therapy (MHT) may offer a meaningful protective effect against esophagogastric cancers, particularly esophageal adenocarcinoma. The research, spanning data from five Nordic countries between 1995 and 2020, adds weight to previous observations but overcomes limitations of earlier studies with its extensive dataset and rigorous analysis.
Researchers have long noted an age-related male predominance in esophagogastric cancer incidence, theorizing a connection to fluctuations in sexual hormones throughout life. While prior research hinted at a potential benefit from MHT, the evidence was often inconclusive due to small sample sizes and incomplete data. This new study, presented at UEGW in Berlin, aims to provide a more definitive answer.
Nordic Collaboration Yields Robust Findings
The population-based case-control study analyzed data from 19,518 women diagnosed with esophagogastric cancer and a control group of 195,094 women, carefully matched by age, country, and year. Data were sourced from comprehensive national registries across Denmark, Finland, Iceland, Norway, and Sweden, encompassing medication records, diagnoses, cancer incidence, population sta
The study found a significant inverse association between MHT use and the risk of several esophagogastric cancers. For esophageal adenocarcinoma, the odds ratios (ors) for different levels of cumulative defined daily doses (DDD) of MHT were as follows: 0.73 (95% CI [0.67-0.79]) for exposure below 158 DDD, 0.68 (95% CI [0.61-0.75]) for exposure between 158 and 848 DDD, and 0.68 (95% CI [0.61-0.75]) for exposure exceeding 848 DDD. A similar trend was observed for esophageal squamous cell carcinoma, with odds ratios of 0.69 (95% CI [0.62-0.77]), 0.70 (95% CI [0.62-0.77]), and 0.71 (95% CI [0.64-0.79]) for the same exposure categories.
The protective effect was also evident for noncardial gastric adenocarcinoma, with adjusted relative risks of 0.90 (95% CI [0.84-0.96]), 0.85 (95% CI [0.79-0.91]), and 0.80 (95% CI [0.74-0.86]) corresponding to the three exposure levels.
Combination Therapy and Systemic Delivery Show Strongest Benefit
Further analysis indicated that combined estrogen-progestin HRT (OR = 0.68 [0.63-0.73]) offered greater risk reduction for esophageal and cardiac adenocarcinomas than estrogen-only MHT (OR = 0.77 [0.69-0.87]). Similarly,systemic MHT demonstrated a stronger association with reduced risk (OR = 0.67 [0.61-0.74]) compared to local MHT (OR = 0.72 [0.66-0.78]).
“The results were consistent across all cancer types analyzed,” researchers noted, “although the magnitude of the protective effect was less pronounced for non-cardiac gastric adenocarcinomas.”
Cautious Optimism and Future Research
While the study confirms a significant inverse association between MHT use and esophagogastric cancer risk, researchers acknowledge a key limitation: the lack of data on socio-economic factors, which could influence the interpretation of these findings.Despite this, the large scale and robust methodology of the study provide compelling evidence.
The findings suggest a potentially protective role for female sex hormones in the development of esophagogastric cancers, particularly esophageal adenocarcinoma, with the effect appearing dose-dependent and amplified by combined estrogen-progestin formulations and systemic delivery. These results,while requiring further confirmation,offer a promising avenue for future research into the prevention and treatment of these aggressive cancers. .
