© 2001 by Oxford University Press
Journal of the National Cancer Institute, Vol. 93, No. 23, 1799-1805,
December 5, 2001
© 2001 Oxford University Press
REPORT |
Hormone Replacement Therapy and Colorectal Adenoma Recurrence Among Women in the Polyp Prevention Trial
For the Polyp Prevention Study Group
Affiliations of authors: K. Woodson, E. Lanza, J. A. Tangrea (Cancer Prevention Studies Branch, Division of Clinical Sciences), P. S. Albert (Biometric Research Branch, Division of Cancer Treatment and Diagnosis), A. Schatzkin (Nutritional Epidemiology Branch, Division of Epidemiology and Genetics), National Cancer Institute, Bethesda, MD; M. Slattery, University of Utah, Salt Lake City; J. Pinsky, Westat, Rockville, MD; B. Caan, Kaiser Foundation Research Institute, Oakland, CA; E. Paskett, Wake Forest University School of Medicine, Winston-Salem, NC; F. Iber, Edward Hines, Jr. Hospital, Department of Veterans Affairs Medical Center, Hines, IL; W. Kikendall, Walter Reed Army Medical Center, Washington, DC; P. Lance, School of Medicine and Biomedical Sciences, State University of New York at Buffalo; M. Shike, Memorial Sloan-Kettering Cancer Center, New York, NY; J. Weissfeld, University of Pittsburgh, PA.
Correspondence to: Karen Woodson, Ph.D., M.P.H., National Institutes of Health, 6006 Executive Blvd., MSC 7058, Bethesda, MD 20892–7058 (e-mail: woodsonk{at}mail.nih.gov).
Background: Epidemiologic studies have suggested that estrogen may protect against the development of colorectal cancers and adenomatous polyps. We conducted a prospective study to evaluate the association between hormone replacement therapy (HRT) and adenoma recurrence among perimenopausal and postmenopausal women participating in the Polyp Prevention Trial, a randomized dietary intervention study of individuals with colorectal adenomas. Methods: We used a questionnaire and interviews to collect detailed information, at baseline and at each of four annual study visits, from 620 women regarding hormone use, menopausal status, diet, alcohol consumption, and other risk factors. Adenoma recurrence was ascertained by complete colonoscopy at baseline and after 1 and 4 years. Logistic regression models were used to evaluate the association between hormone use and adenoma recurrence after adjusting for intervention group and for age and body mass index at baseline. All statistical tests were two-sided. Results: Adenomas recurred in 200 women. There was no overall association between adenoma recurrence and either overall hormone use (odds ratio [OR] = 1.01; 95% confidence interval [CI] = 0.70 to 1.45), combined estrogen and progestin use (OR = 0.94; 95% CI = 0.57 to 1.56), or unopposed estrogen use (OR = 1.04; 95% CI = 0.68 to 1.59). HRT use was associated with a reduction in risk for recurrence of distal adenomas (OR = 0.56; 95% CI = 0.32 to 1.00) and a statistically nonsignificant increase in risk for recurrence of proximal adenomas (OR = 1.39; 95% CI = 0.85 to 2.26). We observed a statistically significant interaction between the HRT–adenoma recurrence association and age (P = .02). HRT was associated with a 40% reduced risk of adenoma recurrence among women older than 62 years (OR = 0.58; 95% CI = 0.35 to 0.97) but with an increased risk among women younger than 62 years (OR = 1.99; 95% CI = 1.11 to 3.55). Conclusions: HRT was not associated with a reduced risk for overall adenoma recurrence in this trial cohort, although there was a suggestion of an age interaction. The effect of age on the association needs to be confirmed in other adenoma recurrence trials.
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