Hormone Replacement Therapy Heightens Risk of Lung Cancer Death

Although the onset of menopause brings with it a variety of unsettling symptoms ranging from hot flashes and night sweats to increased anxiety, irritability and more, women may be far better off to suffer these rather than seek the relief brought by hormone replacement therapy. On the heels of news that perimenopause causes temporary memory loss and learning difficulties, adding to the list of grievances of the menopausal state, comes a warning that hormone replacement therapy for menopausal symptoms greatly increases the risk of lung cancer death. A new study suggests that women who take estrogen-progestin pills and also develop lung cancer are at a 60 percent greater risk of dying from the disease than women who do not take hormones and develop lung cancer.

Dr. Rowan Chlebowski of Harbor-UCLA Medical Center in Los Angeles, who led the study, said that the findings of the analysis indicate that smokers who receive hormone replacement therapy (HRT) should stop taking the hormones and for those smokers who are contemplating HRT, careful consideration should be given prior to commencing it. Experts have already warned women who take hormones to use the lowest dose for the shortest duration possible, and to this warning Chlebowski added, “Women almost certainly shouldn't be using combined hormone therapy and tobacco at the same time.” The results of the study were recently presented at a meeting of the oncology society in Florida.

This latest analysis used data from the Women’s Health Initiative study, a federal study in which 16,608 women were given either Prempro, a drug combining estrogen and progestin, or a placebo. The average age of women in the study was 63, and the participants used high doses of Prempro over long periods of time. The study was halted in 2002 after it was discovered that more breast cancers were occurring in those women receiving the Prempro, demonstrating that the HRT increased the risk of breast cancer. The women who participated in the original Health Initiative study continue to be followed.

The current study focused the most common type of lung cancer known as non-small-cell lung cancer. After five and one-half years on HRT and more than two years of follow-up, no significant difference in the number of incidence of lung cancer that developed was noted in hormone users. However, an alarming 46 percent of lung cancer occurrences proved fatal in hormone users compared to only 27 percent of those who received placebo. HRT accounted for one extra death from non-small-cell lung cancer per 100 women in the study. The researchers have not yet studied lung cancer risk in those who took estrogen alone without progestin.

Chlebowski noted that previous research suggests that hormones play a role in non-small cell lung cancer since women tend to have higher survival rates than men and are known to have a more positive response to certain therapies. However, Dr. Len Lichtenfeld of the American Cancer Society said that with only 106 lung cancer deaths occurring in the study to date, that the total deaths are too few to make comprehensive conclusions about risk.

Dr. Joseph Camardo of Wyeth, maker of Prempro, pointed out that women use HRT much differently now than during the period of time the federal study was conducted and that the same risks may not apply with the new patterns of use. Women now start HRT at the age range of 51 to 54, and take the hormones for an average of two years. During the period of the Women’s Health Initiative study, the average age at which women began HRT was 63 with the therapy continuing for more than five years.

Lung cancer is world’s leading cause of cancer death. In 2008, there were more than 215,000 new cases of lung cancer diagnosed and almost 162,000 deaths in the United States alone.