Hormone replacement therapy increases risk for GI cancers in postmenopausal women
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CHICAGO — The odds of having gastric and pancreatic cancers were higher among postmenopausal women on hormone replacement therapy and remained significant after controlling for risk factors, according to data at Digestive Disease Week.
“In the United States, approximately 40% of postmenopausal women use hormone replacement therapy (HRT) — estrogen with or without progesterone,” Somtochukwu Onwuzo, MD, an internal medicine resident at Cleveland Clinic, told Healio. “Over the years, results for most studies showing benefits of HRT were only significant for short-term use of the drug. ... Though we have studies highlighting effects of HRT and reproductive malignancies, the impacts of long-term use of HRT and development of GI malignant neoplasms is lacking.”
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Using the Explorys electronic health record database, Onwuzo and colleagues identified 11,177,050 women aged 65 years and older who used HRT from 1999 to 2022. They conducted three separate analyses to assess the risk for developing esophageal, gastric and pancreatic cancers and controlled for risk factors such as smoking, alcohol consumption, obesity, GERD, Helicobacter pylori infection and type 2 diabetes mellitus.
According to results, the OR for developing gastric cancer in HRT users was 1.74 (95% CI, 1.51-1.99), while the odds were 1.4 (95% CI, 1.26-1.56) and 0.93 (95% CI, 0.79-1.08) for developing gastric and esophageal cancers, respectively.
“Postmenopausal women on HRT have increased prevalence and odds of having gastric cancer and pancreatic cancers,” Onwuzo said. “The odds remained significant when controlled for common risk factors. Interestingly, we also observed a decreased risk for esophageal cancer in the HRT population.”
He added, “The U.S. Preventive Services Task Force agrees that evidence is lacking to guide recommendations for or against the use of HRT. We push that clinicians be familiar with these associations. The decision to initiate drug use should be solely based on the patient's willingness and complete understanding of benefits and potential risk factors.”
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Onwuzo S, et al. Abstract 117: Prevalence and risk factors associated with upper gastrointestinal malignancies in post-menopausal patients on hormone replacement therapy: A population-based study. Presented at: Digestive Disease Week; May 6-9, 2023; Chicago (hybrid).
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