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Oestrogen plus progestin and lung cancer in postmenopausal women (Womens Health Initiative trial): a post-hoc analysis of a randomised controlled trial
The Lancet, 10/12/09

Chlebowski RT et al. – Although treatment with oestrogen plus progestin in postmenopausal women did not increase incidence of lung cancer, it increased the number of deaths from lung cancer, in particular deaths from non-small-cell lung cancer. These findings should be incorporated into risk—benefit discussions with women considering combined hormone therapy, especially those with a high risk of lung cancer

Methods

16 608 postmenopausal
Randomised, double-blind, placebo-controlled trial undertaken in 40 centres in the USA
16 608 postmenopausal women aged 50—79 years with an intact uterus
Randomly assigned by computerised, stratified, permuted block algorithm to receive once-daily tablet of 0·625 mg conjugated equine oestrogen plus 2·5 mg medroxyprogesterone acetate (n=8506) or matching placebo (n=8102)
Assessed incidence and mortality rates for all lung cancer, SCLC, and NSCLC by use of data from treatment and post-intervention follow-up periods
Analysis was by intention to treat

Results

After mean of 5·6 years (SD 1·3) of treatment and 2·4 years (0·4) of additional follow-up, 109 women in combined hormone therapy group diagnosed with lung cancer compared with 85 in placebo group (incidence per year 0·16% vs 0·13%; hazard ratio [HR] 1·23, 95% CI 0·92—1·63)
96 women assigned combined therapy had NSCLC compared with 72 assigned to placebo (0·14% vs 0·11%; HR 1·28, 0·94—1·7)
More women died from lung cancer in combined hormone therapy group than in placebo group (73 vs 40 deaths; 0·11% vs 0·06%; HR 1·71, 1·16—2·52), mainly as result of higher number of deaths from NSCLC in combined therapy group (62 vs 31 deaths; 0·09% vs 0·05%; HR 1·87, 1·22—2·88)
Incidence and mortality rates of SCLC similar between groups