The type and duration of MHT use influenced survival benefit. In this study, estrogen-only MHT was not beneficial unless used for at least 11 years, whereas any use of combination MHT conveyed a significant benefit (Table 1). Longer duration use had a more substantial effect. MHT use also conveyed a survival benefit regardless of smoking status, with a more potent effect among never-smokers.6

Table 1: Hazard Ratio (95% CI) With Use of Menopausal Hormone Therapy6


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Women Hormone Therapy (HT) Type Smoking Status
All Post-
menopausal
Estrogen Comb-
ination
Never Current/
Former
Ever- vs Never-HT Use 0.69
(0.54–0.88)
0.72
(0.56–0.92)
0.79
(0.59–1.04)
0.64
(0.47–0.86)
0.19
(0.05–0.73)
0.73
(0.57–0.94)

In the study discussion, lead author Hannah Katcoff, BA, of the University of Michigan School of Public Health in Ann Arbor, noted that the WHI study has the strength of being randomized, but is somewhat limited because of lack of treatment data and a limited duration of MHT use. The present study, she said, includes a large sample, detailed MHT information, and a large proportion of MHT users in the sample. Limitations include a reliance on recall for some data. Perhaps more importantly, women who were interviewed were by definition healthy enough to participate, and overall survival in the sample may be longer than expected in a randomly selected group. This has implications for the generalizability of the findings.

In summary, a population-based study of women with lung cancer, almost all postmenopausal, has found a survival benefit in NSCLC associated with any use of combination HT and use of estrogen-only HT for 11 years or longer. Longer duration of use conveyed a stronger benefit. These results contrast with those of the WHI, suggesting that additional research is needed to further elucidate what, if any, role HT plays in NSCLC survival. 

References

  1. American Cancer Society. Cancer Facts & Figures 2014. Atlanta: American Cancer Society; 2014. http://www.cancer.org/research/cancerfactsstatistics/cancerfactsfigures2014/index. Accessed May 12, 2014.
  2. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Non-Small Cell Lung Cancer. V2.2013. www.nccn.org.
  3. Chlebowski RT, Schwartz AG, Wakelee H, et al. Estrogen plus progestin and lung cancer in postmenopausal women: a post-hoc analysis of a randomized controlled trial. Lancet. 2009;374(9697):1243-1251.
  4. Brinton LA, Schwartz L, Spitz MR, et al. Unopposed estrogen and estrogen plus progesterone menopausal hormone therapy and lung cancer risk in the NIH-AARP Diet and Health Study cohort. Cancer Causes Contr. 2012;23(3):487-496.
  5. Pesatori AC, Carugno M, Consonni D, et al. Hormone use and risk for lung cancer: a pooled analysis from the International Lung Cancer Consortium (ILCCO). Br J Cancer. 2013;109(7):1954-1964.
  6. Katcoff H, Wenzlaff AS, Schwartz AG. Survival in women with NSCLC: the role of reproductive history and hormone use. J Thorac Oncol. 2014;9(3):355-361.
  7. Chlebowski RT, Anderson GL, Manson JE, et al. Lung cancer among postmenopausal women treated with estrogen alone in the Women’s Health Initiative randomized trial. J Natl Cancer Inst. 2010;102(18):1413-1421.