Reproductive Factors, Hormone Use, and Risk for Lung Cancer in Postmenopausal Women, the Nurses' Health Study

ArticleinCancer Epidemiology Biomarkers & Prevention 19(10):2525-33 · October 2010with40 Reads
DOI: 10.1158/1055-9965.EPI-10-0450 · Source: PubMed
There is increasing evidence suggesting that female hormones may play a significant role in lung cancer development. We evaluated the associations between reproductive factors, exogenous hormone use, and lung cancer incidence in the Nurses' Health Study. We assessed age at menopause, age at menarche, type of menopause, parity, age at first birth, postmenopausal hormone (PMH) use, and past oral contraceptive use in 107,171 postmenopausal women. Cox models were used to estimate the hazard ratios for each exposure, adjusting for smoking and other covariates. We identified 1,729 lung cancer cases during follow-up from 1984 to 2006. Menopause onset before 44 years of age (hazard ratio, 1.39; 95% confidence interval, 1.14-1.70) and past oral contraceptive use for >5 years (hazard ratio, 1.22; 95% confidence interval, 1.05-1.42) were associated with increased lung cancer risk. These associations were strongest in current smokers and small cell histology. In never smokers, increased parity was associated with decreased risk among parous women (P trend = 0.03), whereas in current smokers, older age at first birth was associated with increased risk (P trend = 0.02). PMH use was not associated with overall lung cancer incidence. However, nonsignificant results of increased risk in adenocarcinoma were seen with current PMH use. Our findings suggest female hormones may influence lung carcinogenesis, although the effect is likely modest, varied by histologic subtype, and altered by smoking. Further investigation of the pathophysiology of female hormones in lung cancer subtypes and their interaction with smoking will lead to better understanding of lung carcinogenesis.
    • "use of estrogens and lC risk, however their findings appear inconclusive (Chen, Cai, 2009; Pesatori et al., 2013; Wu et al., 2014a). Pesatori et al. (2013) reported a statistically significant decrease in risk compared to Baik et al. (2010) who found an increased risk among long time estrogens users (>5 years). Chen, Cai (2009), however, observed no association. "
    [Show abstract] [Hide abstract] ABSTRACT: diagnosis of lung cancer (lC) has been fraught with difficulty and by the time of definitive diagnosis, most patients are in later stages of the disease. epidemiological studies have demonstrated that lifestyle behaviors play an etiological role in lC risk; however data in the literature on this topic often appears inconclusive or require further study. Understanding of the mechanisms operating between lifestyle patterns and their impact on lC is important for the disease's prevention and treatment. the purpose of this study was to review the current evidence on the role of diet, body mass index (BMi), physical activity, smoking, alcohol consumption, and sex hormone use in lC development based on meta-analyses, systematic reviews and previously published epidemiologic studies. Regarded as the foremost cause of lC, evidence from studies have indicated that tobacco smoking causes lC. additionally, exposure to outdoor air pollution and/or occupational-related exposures increase lC risk. Further, frequent consumption of red meat, processed meat increases adenocarcinoma and squamous cell carcinoma. Inverse associations between the disease risk and BMI ≥25 kg/m 2 , higher level of physical activity, and fruit and vegetable consumption with a high frequency were reported. Future studies are warranted to validate the association between histologic subtypes of lC and lifestyle patterns.
    Full-text · Article · Jan 2016
    • "Our data was limited as we were unable to ascertain the specific formulation of contraceptives used. The evidence for HRT use is equivocal, with studies reporting reduced risk [17,23,[31][32][33][34][41][42][43], increased risk [18,21,35,36], and null effect [19,24,[28][29][30][37][38][39]. The WHI trial reported a non-significant increase in incidence and a significant increase in mortality in women randomized to the estrogen and progestin combination arm [35]. "
    [Show abstract] [Hide abstract] ABSTRACT: Objectives: A growing body of literature suggests that female hormones play a role in lung cancer risk. Our study aims to examine the relationship between reproductive factors and lung cancer incidence in a large prospectively enrolled cohort in Singapore. Materials and methods: Multivariate Cox proportional hazard regression models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of lung cancer for each exposure, adjusting for smoking, age at entry, ethnicity and body mass index. Results: Among 28,222 women aged 50-64 years enrolled in the Singapore Breast Cancer Screening Project from October 1994 to February 1997, we identified 311 incident lung cancer cases (253 in non-smokers) over an average of 15.8 years of follow-up to 31 December 2011. Higher parity was associated with decreased lung cancer risk. Compared with nulliparous women, those with 1-2, 3-4, and ≥5 deliveries had a hazard ratio (HR) of 0.56, 0.55 and 0.45, respectively (Ptrend<0.01). This association was observed in both smokers and non-smokers, and in both adenocarcinomas and non-adenocarcinomas. Reproductive period, breastfeeding, oral contraceptive and hormone replacement therapy use did not seem to influence the risk of getting lung cancer. Conclusion: Our findings add to the existing evidence that parous women have a lower lung cancer risk than nulliparous women.
    Full-text · Article · Oct 2015
    • "However, the limited number of observed cases precluded firm conclusions. Most of the scientific literature on oral contraceptive use (OC) points to no association with lung cancer risk (Taioli and Wynder, 1994; Elliott and Hannaford, 2006; Kabat et al, 2007; Schwartz et al, 2007; Weiss et al, 2008; Seow et al, 2009; Hannaford et al, 2010; Vessey et al, 2010; Meinhold et al, 2011), with two possible exceptions showing, however, opposite results: a reduced lung cancer risk among ever OC users in a case–control study (Kreuzer et al, 2003) and a slightly increased risk among women using OC for 45 years in a cohort study (Baik et al, 2010). "
    [Show abstract] [Hide abstract] ABSTRACT: Background: The association between oral contraceptive (OC) use, hormone replacement therapy (HRT) and lung cancer risk in women is still debated. Methods: We performed a pooled analysis of six case–control studies (1961 cases and 2609 controls) contributing to the International Lung Cancer Consortium. Potential associations were investigated with multivariable unconditional logistic regression and meta-analytic models. Multinomial logistic regressions were performed to investigate lung cancer risk across histologic types. Results: A reduced lung cancer risk was found for OC (odds ratio (OR)=0.81; 95% confidence interval (CI): 0.68–0.97) and HRT ever users (OR=0.77; 95% CI: 0.66–0.90). Both oestrogen only and oestrogen+progestin HRT were associated with decreased risk (OR=0.76; 95% CI: 0.61–0.94, and OR=0.66; 95% CI: 0.49–0.88, respectively). No dose-response relationship was observed with years of OC/HRT use. The greatest risk reduction was seen for squamous cell carcinoma (OR=0.53; 95% CI: 0.37–0.76) in OC users and in both adenocarcinoma (OR=0.79; 95% CI: 0.66–0.95) and small cell carcinoma (OR=0.37; 95% CI: 0.19–0.71) in HRT users. No interaction with smoking status or BMI was observed. Conclusion: Our findings suggest that exogenous hormones can play a protective role in lung cancer aetiology. However, given inconsistencies with epidemiological evidence from cohort studies, further and larger investigations are needed for a more comprehensive view of lung cancer development in women.
    Full-text · Article · Sep 2013
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