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By Suzanne Rostler
NEW YORK, Mar 20 (Reuters Health) - Postmenopausal women who use estrogen replacement therapy (ERT) for more than 10 years may be at increased risk of dying from ovarian cancer, a new study reports.
According to Dr. Carmen Rodriguez and colleagues from the American Cancer Society in Atlanta, Georgia, postmenopausal women who used estrogen for at least 10 years were about twice as likely to develop ovarian cancer as their peers who did not take ERT.
Even women who used estrogen for 10 or more years but stopped taking it remained at risk 29 years later, the researchers report in the March 21st issue of The Journal of the American Medical Association.
But the study authors note that women have a less than 2% chance of developing ovarian cancer throughout their lifetime. Therefore, the results of the study should be weighed against the benefits of taking ERT, which include a lower risk of heart disease and osteoporosis.
Furthermore, the findings may not apply to hormone replacement therapy that includes estrogen in combination with other hormones such as progesterone. When the study began in the early 1980s, most women took only estrogen and not a combination of hormones, which is what women take today.
"If the association is real--we have to wait for other studies--these results may be relevant for women with intact ovaries taking estrogen for a long period of time," Rodriguez told Reuters Health. "We still recommend that women talk to their doctors about how the balance of risk and benefits of hormone therapy would balance for them, based on their own health profile."
Ovarian cancer is difficult to treat because it is rarely found in its early stages. According to the American Cancer Society, about 23,000 new cases of ovarian cancer are diagnosed annually, and 14,000 women will die of the disease each year.
Previous studies have shown that ERT may raise the risk of breast and endometrial cancer in postmenopausal women but its influence on ovarian cancer is not clear. To investigate, Rodriguez and colleagues followed nearly 212,000 women for 14 years. About 22% had used ERT.
Among women who had used ERT for at least 10 years, the rate of death due to ovarian cancer was 64.4 per 100,000 women, compared with 38.3 per 100,000 women who discontinued estrogen therapy after at least 10 years of use, and 26.4 per 100,000 women who never used ERT. Using estrogen for less than 10 years did not increase ovarian cancer risk.
Exactly how ERT raises ovarian cancer risk is not known. Rodriguez explained that when estrogen levels are higher, such as during the menstrual cycle, cells in the ovaries proliferate, increasing the chance that they may develop cancerous mutations.
Ovarian cancer most often strikes women aged 65 and older, and in some cases the disease may have a genetic component. Women with chronic inflammation of the pelvic area--for example, those who have endometriosis or pelvic inflammatory disease--may also have an increased risk of developing the disease.
SOURCE: The Journal of the American Medical Association 2001;285:1460-1465.
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