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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

• 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

• 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

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