Hormone use, reproductive history, and risk of lung cancer: The women's health initiative studies

Ann G. Schwartz, Roberta M. Ray, Michele L. Cote, Judith Abrams, Robert J. Sokol, Susan L. Hendrix, Chu Chen, Rowan T. Chlebowski, F. Allan Hubbell, Charles Kooperberg, JoAnn E. Manson, Mary Jo O'Sullivan, Thomas E. Rohan, Marcia L. Stefanick, Jean Wactawski-Wende, Heather Wakelee, Michael S. Simon

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Introduction: Results from the Women's Health Initiative clinical trials demonstrated no increase in the risk of lung cancer in postmenopausal women treated with hormone therapy (HT). We conducted a joint analysis of the Women's Health Initiative observational study data and clinical trials data to further explore the association between estrogen and estrogen-related reproductive factors and lung cancer risk. Methods: Reproductive history, oral contraceptive use, and postmenopausal HT were evaluated in 160,855 women with known HT exposures. Follow-up for lung cancer was through September 17, 2012; 2467 incident lung cancer cases were ascertained, with median follow-up of 14 years. Results: For all lung cancers, women with previous use of estrogen plus progestin of less than 5 years (hazard ratio = 0.84; 95% confidence interval = 0.71-0.99) were at reduced risk. A limited number of reproductive factors demonstrated associations with risk. There was a trend toward decreased risk with increasing age at menopause (p<inf>trend</inf> = 0.04) and a trend toward increased risk with increasing number of live births (p<inf>trend</inf> = 0.03). Reduced risk of non-small-cell lung cancer was associated with age 20-29 years at first live birth. Risk estimates varied with smoking history, years of HT use and previous bilateral oophorectomy. Conclusions: Indirect measures of estrogen exposure to lung tissue, as used in this study, provide only weak evidence for an association between reproductive history or HT use and risk of lung cancer. More detailed mechanistic studies and evaluation of risk factors in conjunction with estrogen receptor expression in the lung should continue as a role for estrogen cannot be ruled out and may hold potential for prevention and treatment strategies.

Original languageEnglish (US)
Pages (from-to)1004-1013
Number of pages10
JournalJournal of Thoracic Oncology
Volume10
Issue number7
DOIs
StatePublished - Jul 4 2015

Fingerprint

Reproductive History
Women's Health
Lung Neoplasms
Hormones
Estrogens
Live Birth
Clinical Trials
Implosive Therapy
Therapeutics
Lung
Birth Order
Ovariectomy
Progestins
Oral Contraceptives
Menopause
Non-Small Cell Lung Carcinoma
Estrogen Receptors
Observational Studies
Smoking
History

Keywords

  • Hormone therapy
  • Lung cancer
  • Reproductive history

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine

Cite this

Schwartz, A. G., Ray, R. M., Cote, M. L., Abrams, J., Sokol, R. J., Hendrix, S. L., ... Simon, M. S. (2015). Hormone use, reproductive history, and risk of lung cancer: The women's health initiative studies. Journal of Thoracic Oncology, 10(7), 1004-1013. https://doi.org/10.1097/JTO.0000000000000558

Hormone use, reproductive history, and risk of lung cancer : The women's health initiative studies. / Schwartz, Ann G.; Ray, Roberta M.; Cote, Michele L.; Abrams, Judith; Sokol, Robert J.; Hendrix, Susan L.; Chen, Chu; Chlebowski, Rowan T.; Hubbell, F. Allan; Kooperberg, Charles; Manson, JoAnn E.; O'Sullivan, Mary Jo; Rohan, Thomas E.; Stefanick, Marcia L.; Wactawski-Wende, Jean; Wakelee, Heather; Simon, Michael S.

In: Journal of Thoracic Oncology, Vol. 10, No. 7, 04.07.2015, p. 1004-1013.

Research output: Contribution to journalArticle

Schwartz, AG, Ray, RM, Cote, ML, Abrams, J, Sokol, RJ, Hendrix, SL, Chen, C, Chlebowski, RT, Hubbell, FA, Kooperberg, C, Manson, JE, O'Sullivan, MJ, Rohan, TE, Stefanick, ML, Wactawski-Wende, J, Wakelee, H & Simon, MS 2015, 'Hormone use, reproductive history, and risk of lung cancer: The women's health initiative studies', Journal of Thoracic Oncology, vol. 10, no. 7, pp. 1004-1013. https://doi.org/10.1097/JTO.0000000000000558
Schwartz, Ann G. ; Ray, Roberta M. ; Cote, Michele L. ; Abrams, Judith ; Sokol, Robert J. ; Hendrix, Susan L. ; Chen, Chu ; Chlebowski, Rowan T. ; Hubbell, F. Allan ; Kooperberg, Charles ; Manson, JoAnn E. ; O'Sullivan, Mary Jo ; Rohan, Thomas E. ; Stefanick, Marcia L. ; Wactawski-Wende, Jean ; Wakelee, Heather ; Simon, Michael S. / Hormone use, reproductive history, and risk of lung cancer : The women's health initiative studies. In: Journal of Thoracic Oncology. 2015 ; Vol. 10, No. 7. pp. 1004-1013.
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abstract = "Introduction: Results from the Women's Health Initiative clinical trials demonstrated no increase in the risk of lung cancer in postmenopausal women treated with hormone therapy (HT). We conducted a joint analysis of the Women's Health Initiative observational study data and clinical trials data to further explore the association between estrogen and estrogen-related reproductive factors and lung cancer risk. Methods: Reproductive history, oral contraceptive use, and postmenopausal HT were evaluated in 160,855 women with known HT exposures. Follow-up for lung cancer was through September 17, 2012; 2467 incident lung cancer cases were ascertained, with median follow-up of 14 years. Results: For all lung cancers, women with previous use of estrogen plus progestin of less than 5 years (hazard ratio = 0.84; 95{\%} confidence interval = 0.71-0.99) were at reduced risk. A limited number of reproductive factors demonstrated associations with risk. There was a trend toward decreased risk with increasing age at menopause (ptrend = 0.04) and a trend toward increased risk with increasing number of live births (ptrend = 0.03). Reduced risk of non-small-cell lung cancer was associated with age 20-29 years at first live birth. Risk estimates varied with smoking history, years of HT use and previous bilateral oophorectomy. Conclusions: Indirect measures of estrogen exposure to lung tissue, as used in this study, provide only weak evidence for an association between reproductive history or HT use and risk of lung cancer. More detailed mechanistic studies and evaluation of risk factors in conjunction with estrogen receptor expression in the lung should continue as a role for estrogen cannot be ruled out and may hold potential for prevention and treatment strategies.",
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AU - Schwartz, Ann G.

AU - Ray, Roberta M.

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AU - Abrams, Judith

AU - Sokol, Robert J.

AU - Hendrix, Susan L.

AU - Chen, Chu

AU - Chlebowski, Rowan T.

AU - Hubbell, F. Allan

AU - Kooperberg, Charles

AU - Manson, JoAnn E.

AU - O'Sullivan, Mary Jo

AU - Rohan, Thomas E.

AU - Stefanick, Marcia L.

AU - Wactawski-Wende, Jean

AU - Wakelee, Heather

AU - Simon, Michael S.

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N2 - Introduction: Results from the Women's Health Initiative clinical trials demonstrated no increase in the risk of lung cancer in postmenopausal women treated with hormone therapy (HT). We conducted a joint analysis of the Women's Health Initiative observational study data and clinical trials data to further explore the association between estrogen and estrogen-related reproductive factors and lung cancer risk. Methods: Reproductive history, oral contraceptive use, and postmenopausal HT were evaluated in 160,855 women with known HT exposures. Follow-up for lung cancer was through September 17, 2012; 2467 incident lung cancer cases were ascertained, with median follow-up of 14 years. Results: For all lung cancers, women with previous use of estrogen plus progestin of less than 5 years (hazard ratio = 0.84; 95% confidence interval = 0.71-0.99) were at reduced risk. A limited number of reproductive factors demonstrated associations with risk. There was a trend toward decreased risk with increasing age at menopause (ptrend = 0.04) and a trend toward increased risk with increasing number of live births (ptrend = 0.03). Reduced risk of non-small-cell lung cancer was associated with age 20-29 years at first live birth. Risk estimates varied with smoking history, years of HT use and previous bilateral oophorectomy. Conclusions: Indirect measures of estrogen exposure to lung tissue, as used in this study, provide only weak evidence for an association between reproductive history or HT use and risk of lung cancer. More detailed mechanistic studies and evaluation of risk factors in conjunction with estrogen receptor expression in the lung should continue as a role for estrogen cannot be ruled out and may hold potential for prevention and treatment strategies.

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