Estrogen metabolism in menopausal hormone users in the women's health initiative observational study: Does it differ between estrogen plus progestin and estrogen alone?

Roni T. Falk, Jo Ann E. Manson, Vanessa M. Barnabei, Garnet L. Anderson, Louise A. Brinton, Thomas E. Rohan, Jane A. Cauley, Chu Chen, Sally B. Coburn, Ruth M. Pfeiffer, Kerryn W. Reding, Gloria E. Sarto, Nicolas Wentzensen, Rowan T. Chlebowski, Xia Xu, Britton Trabert

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

The WHI found an unexpected reduced breast cancer risk in women using CEE alone. We hypothesized CEE alone induces estrogen hydroxylation along the 2-pathway rather than the competing 16-pathway, a pattern linked to reduced postmenopausal breast cancer risk. One thousand eight hundred and sixty-four women in a WHIOS case–control study of estrogen metabolism and ovarian and endometrial cancer were studied of whom 609 were current E + P users (351 used CEE + MPA), while 272 used E alone (162 used CEE). Fifteen EM were measured, and analyses were conducted for each metabolite, hydroxylation pathway (2-, 4-, or 16-pathway) and ratios of pathway concentrations using inverse probability weighted linear regression. Compared to E + P users, all EM were higher in E alone users (significant for unconjugated estrone, total/conjugated estradiol, total/unconjugated 2-methoxyestrone, 4-methoxyestrone and unconjugated estriol). The relative concentrations of 2- and 4-pathway EM did not differ between the MHT users (2-pathway EM comprised 15% and 4-pathway EM <2% of the total), but 16-pathway EM were lower in E alone users (p = 0.036). Ratios of 2- and 4-pathway EM compared to 16-pathway EM were significantly higher in E alone compared to E + P users. Similar but not significant patterns were observed in CEE-alone and CEE + MPA users. Our data suggest that compared to E + P users, women using E alone have more extensive metabolism via the 2- vs. the competing 16-pathway. This is consistent with epidemiologic evidence of reduced postmenopausal breast cancer risk associated with this metabolic profile and may provide a clue to the breast cancer risk reduction in CEE alone users during the WHI.

Original languageEnglish (US)
Pages (from-to)730-740
Number of pages11
JournalInternational Journal of Cancer
Volume144
Issue number4
DOIs
StatePublished - Feb 15 2019

Keywords

  • conjugated equine estrogens
  • conjugated equine estrogens plus medroxyprogesterone acetate
  • estrogen alone
  • estrogen metabolism
  • estrogen plus progestin
  • women's health initiative observational study

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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  • Cite this

    Falk, R. T., Manson, J. A. E., Barnabei, V. M., Anderson, G. L., Brinton, L. A., Rohan, T. E., Cauley, J. A., Chen, C., Coburn, S. B., Pfeiffer, R. M., Reding, K. W., Sarto, G. E., Wentzensen, N., Chlebowski, R. T., Xu, X., & Trabert, B. (2019). Estrogen metabolism in menopausal hormone users in the women's health initiative observational study: Does it differ between estrogen plus progestin and estrogen alone? International Journal of Cancer, 144(4), 730-740. https://doi.org/10.1002/ijc.31851