Development of Endometrial Cancer in Women on Estrogen and Progestin Hormone Replacement Therapy

• Published in: Gynecologic oncology Vol. 55; no. 1; pp. 126 - 132
• Main Authors: McGonigle, Kathryn F., Karlan, Beth Y., Barbuto, Denise A., Leuchter, Ronald S., Lagasse, Leo D., Judd, Howard L.
• Format: Journal Article
• Language: English
• Published: San Diego, CA Elsevier Inc 01.10.1994; Elsevier
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Biopsy; Dose-Response Relationship, Drug; Drug Therapy, Combination; Endometrial Neoplasms - chemically induced; Endometrial Neoplasms - pathology; Endometrial Neoplasms - surgery; Estrogen Replacement Therapy - adverse effects; Estrogens - administration & dosage; Estrogens - adverse effects; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; Humans; Medical sciences; Medroxyprogesterone Acetate - adverse effects; Middle Aged; Neoplasm Staging; Norethindrone - adverse effects; Norethindrone - analogs & derivatives; Progestins - administration & dosage; Progestins - adverse effects; Retrospective Studies; Tumors; Human; Replacement therapy; Estroprogestagen; Estrogen; Uterine diseases; Postmenopause; Malignant tumor; Endometrium; Female genital diseases; Progestagen
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1006/gyno.1994.1261

The presenting symptoms, hormonal regimens, treatment modalities, tumor pathology, and follow-up of 25 women developing endometrial cancer while receiving postmenopausal estrogen and progestin therapy were investigated retrospectively. Patients were interviewed and hormone therapies were confirmed through medical records. Pathology specimens were reviewed. Patients received conjugated estrogens ( n = 20) or another estrogen ( n = 5). For those on conjugated estrogens, the mean daily dose was 0.68 mg, monthly duration was 24.9 days, and monthly dose was 17.0 mg. Women also received medroxyprogesterone acetate ( n = 23) or norethindrone acetate ( n = 2). The most common regimen was sequential medroxyprogesterone acetate, at a mean daily dose of 7.5 mg, monthly duration of 9.3 days, and monthly dose of 68 mg (mean duration = 5.7 years). Most tumors were low stage and grade, with few demonstrating grade 3 disease ( n = 2) or greater than 50% myometrial invasion ( n = 2). Twenty-three (92%) had disease limited to the uterus, while two had singe IIIA disease. All are alive and disease-free after a median follow-up of 26 months. Estrogen and progestin therapy does not prevent endometrial cancer in all patients. Women who developed this tumor on sequential therapy in general received less than the recommended guidelines for daily dosage and monthly duration of progestin. Most patients had early-stage and low-grade disease. Continued vigilance in the care of women on hormone replacement therapy is necessary even when combination therapy is prescribed.