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Estrogen Replacement and Risk for Recurrence of Endometrial Cancer
Estrogen replacement therapy (ERT) after surgery for endometrial cancer remains controversial, in part because retrospective studies have lacked well-matched control groups. From a cohort of 249 women treated for stage I to III endometrial cancer between 1984 and 1998, California investigators matched 75 ERT users with 75 controls by decade of age at diagnosis and by disease stage. All 150 subjects had undergone total abdominal hysterectomies and bilateral salpingo-oophorectomies.
Most ERT users had received conjugated estrogens (0.625 mg daily), and 57 percent had initiated treatment within 6 months of surgery. All ERT users had routinely been offered medroxyprogesterone acetate (2.5 mg daily); 49 percent accepted this addition, which has been shown to inhibit estrogen's effects on the endometrium.
Mean follow-up was 83 months for ERT users and 69 months for nonusers. Recurrence rates were 3 percent (2 patients) and 15 percent (11), respectively; data were insufficient to determine whether ERT might have had a protective effect. One patient in each group died of endometrial cancer.
Comment: These data suggest that ERT use does not increase endometrial cancer recurrence rates. The authors note that theirs is "the largest controlled experience to date with a follow-up period that is adequate to detect recurrent disease." Clearly, more definitive conclusions await results from randomized clinical trials, but even these uncontrolled reports have prompted the NIH to fund a prospective trial of ERT after surgery for early-stage endometrial cancer.
— RW Rebar
Published in Journal Watch General Medicine April 24, 2001
Citation(s):
Suriano KA et al. Estrogen replacement therapy in endometrial cancer patients: A matched control study. Obstet Gynecol 2001 Apr 97 555-560.
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