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-
Estrogen Comb-
Never Current/
Ever- vs Never-HT Use 0.69

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. 


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