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Reproductive Factors, Hormone Use, Estrogen Receptor Expression and Risk of Non–Small-Cell Lung Cancer in Women

Ann G. Schwartz, Angela S. Wenzlaff, Geoffrey M. Prysak, Valerie Murphy, Michele L. Cote, Sam C. Brooks, Debra F. Skafar, Fulvio Lonardo

From the Population Studies and Prevention Program, Breast Cancer Program, and Developmental Therapeutics Program, Karmanos Cancer Institute; Departments of Internal Medicine, Biochemistry and Molecular Biology, Physiology, and Pathology, Wayne State University School of Medicine, Detroit, MI

Address reprint requests to Ann G. Schwartz, PhD, MPH, Karmanos Cancer Institute, 110 E Warren Ave, Detroit, MI 48201; e-mail: schwarta{at}karmanos.org

Purpose: Estrogen receptor (ER) expression in lung tumors suggests that estrogens may play a role in the development of lung cancer. We evaluated the role of hormone-related factors in determining risk of non–small-cell lung cancer (NSCLC) in women. We also evaluated whether risk factors were differentially associated with cytoplasmic ER- and/or nuclear ER-β expression–defined NSCLC in postmenopausal women.

Patients and Methods: Population-based participants included women aged 18 to 74 years diagnosed with NSCLC in metropolitan Detroit between November 1, 2001 and October 31, 2005. Population-based controls were identified through random digit dialing, matched to patient cases on race and 5-year age group. Interview data were analyzed for 488 patient cases (241 with tumor ER results) and 498 controls.

Results: Increased duration of hormone replacement therapy (HRT) use in quartiles was associated with decreased risk of NSCLC in postmenopausal women (odds ratio = 0.88; 95% CI, 0.78 to 1.00; P = .04), adjusting for age, race, pack-years, education, family history of lung cancer, current body mass index, years exposed to second-hand smoke in the workplace, and obstructive lung disease history. Among postmenopausal women, ever using HRT, increasing HRT duration of use in quartiles, and increasing quartiles of estrogen use were significant predictors of reduced risk of NSCLC characterized as ER- and/or ER-β positive. None of the hormone-related variables were associated with nuclear ER-–or ER-β–negative NSCLC.

Conclusion: These findings suggest that postmenopausal hormone exposures are associated with reduced risk of ER-–and ER-β–expressing NSCLC. Understanding tumor characteristics may direct development of targeted treatment for this disease.

Supported by National Institutes of Health Grant No. R01-CA87895 and Contracts No. N01-PC35145 and P30CA22453.

Presented in part at the Annual Meeting of the North American Association of Central Cancer Registries, Detroit, MI, June 5-7, 2007.

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

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