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Hormone Replacement Therapy and Survival After Colorectal Cancer Diagnosis

Jennifer A. Chan, Jeffrey A. Meyerhardt, Andrew T. Chan, Edward L. Giovannucci, Graham A. Colditz, Charles S. Fuchs

From the Dana-Farber Cancer Institute; Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; and Massachusetts General Hospital, Boston, MA

Address reprint requests to Jennifer A. Chan, MD, MPH, Dana-Farber Cancer Institute, Dana 1220, 44 Binney St, Boston, MA 02115; e-mail: jang{at}partners.org

PURPOSE: Postmenopausal estrogen use has been shown to decrease the incidence of colorectal cancer, but there is limited information regarding the effect of estrogen use on survival after diagnosis of colorectal cancer.

PARTICIPANTS AND METHODS: We examined the influence of postmenopausal estrogen use on mortality among 834 women participating in the Nurses' Health Study who were diagnosed with colorectal cancer between 1976 and 2000 and observed until death or June 2004, whichever came first. Colorectal cancer–specific mortality and overall mortality according to categories of hormone use were assessed. Cox proportional hazards models were used to calculate hazard ratios (HRs) adjusted for other risk factors for cancer survival.

RESULTS: Postmenopausal estrogen use before diagnosis of colorectal cancer was associated with significant reduction in mortality. Compared with women with no prior estrogen use, those reporting current use before diagnosis had an adjusted HR of 0.64 (95% CI, 0.47 to 0.88) for colorectal cancer–specific mortality and 0.74 (95% CI, 0.56 to 0.97) for overall mortality. This inverse association between hormone use and mortality was most evident among women whose duration of use was less than 5 years. Longer durations and past use were not associated with significant survival benefit. Assessment of estrogen use after diagnosis demonstrated similar findings.

CONCLUSION: Current postmenopausal estrogen use before diagnosis of colorectal cancer was associated with improved colorectal cancer–specific and overall mortality. This benefit was principally limited to women who initiated estrogens within 5 years of diagnosis. Additional efforts to understand mechanisms through which estrogens influence colorectal carcinogenesis and cancer progression seem warranted.

Supported by Grant No. T32 CA 09001 from the National Institutes of Health (J.A.C.). The Nurses' Health Study is supported in part by Grant No. P01CA087969 from the National Cancer Institute.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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