Hormone replacement therapy and cancer mortality in women with 17 site-specific cancers: a cohort study using linked medical records

Sep 21, 2026

Uploaded by Oliver

Limited evidence exists on the safety of hormone replacement therapy (HRT) for women who have cancer. This cohort study used linked medical records to examine HRT use after diagnosis and cancer-specific mortality across 17 site-specific cancers. Women newly diagnosed between 1998 and 2019 were identified from general practitioner records, hospital diagnoses, and cancer registries in Scotland, Wales, and England. Excluding breast cancer patients, the primary analysis assessed time to cancer-specific death using time-dependent Cox regression. No increase in cancer-specific mortality was found among systemic HRT users versus non-users.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Background

Methods

Results

Conclusions

Methods

Data sources and cohort identification

Outcome and statistical analysis

British Journal of Cancer [www.nature.com/bjc](www.nature.com/bjc) ARTICLE OPEN Epidemiology Hormone replacement therapy and cancer mortality in women with 17 site-speciﬁc cancers: a cohort study using linked medical records Chris R. Cardwell 1 ✉, Tom A. Ranger2, Alexander M. Labeit1, Carol A. C. Coupland 3, Blánaid Hicks 1, Carmel Hughes4,Úna McMenamin 1, Xue W. Mei2, Peter Murchie 5 and Julia Hippisley-Cox 2 © The Author(s) 2024 BACKGROUND: There is limited evidence on the safety of Hormone Replacement Therapy (HRT) in women with cancer. Therefore, we systematically examined HRT use and cancer-speciﬁc mortality in women with 17 site-speciﬁc cancers. METHODS: Women newly diagnosed with 17 site-speciﬁc cancers from 1998 to 2019, were identiﬁed from general practitioner (GP) records, hospital diagnoses or cancer registries in Scotland, Wales and England. Breast cancer patients were excluded because HRT is contraindicated in breast cancer patients. The primary outcome was time to cancer-speciﬁc mortality. Time-dependent Cox regression models were used to calculate adjusted hazard ratios (HR) and 95% conﬁdence intervals (95% CIs) for cancer-speciﬁc mortality by systemic HRT use. RESULTS: The combined cancer cohorts contained 182,589 women across 17 cancer sites. Overall 7% of patients used systemic HRT after their cancer diagnosis. There was no evidence that HRT users, compared with non-users, had higher cancer-speciﬁc mortality at any cancer site. In particular, no increase was observed in common cancers including lung (adjusted HR = 0.98 95% CI 0.90, 1.07), colorectal (adjusted HR = 0.79 95% CI 0.70, 0.90), and melanoma (adjusted HR = 0.77 95% CI 0.58, 1.02) . CONCLUSIONS: We observed no evidence of increased cancer-speciﬁc mortality in women with a range of cancers (excluding breast) receiving HRT. British Journal of Cancer (2024) 131:737–746; [https://doi.org/10.1038/s41416-024-02767-8](https://doi.org/10.1038/s41416-024-02767-8) BACKGROUND Hormone replacement therapy (HRT) is widely used to reduce menopausal related vasomotor symptoms (hot ﬂushes, and night sweats) [1], urogenital atrophy [1] and postmenopausal osteoporosis [2] . It has also been shown to reduce joint pain, moodswings, sleep disturbances and improve quality of life [1] . The earlier detection and improved survival of patients with cancer has led to increasing numbers of women with cancer experiencing menopausal symptoms. In the United Kingdom (UK) HRT is contraindicated in patients with breast cancer and oestrogendependent cancers [2–4] but is not contraindicated in patients with other cancers. Clinicians may be reluctant to treat menopausal symptoms in patients with cancer using HRT given uncertainty around the impact of HRT on cancer outcomes, but denial of HRT without clear indication has been criticised by some authors as it could lead to unnecessary suffering [5, 6] . Some researchers summarising evidence on the safety of HRT use in patients with cancer have advised caution when prescribing HRT to patients with several cancers including bladder, gastric and lung cancer [7, 8] . These recommendations were partly based on preclinical studies suggesting that oestrogen stimulates growth in bladder [9] and gastric cancer cell lines [10] and lung cancer mouse models [11] . Further, observational studies have shown increases in the risk of glioma and meningioma with use of oestrogen alone HRT [12] and the Women’s Health Initiative randomised controlled trial (RCT) showed a marked increase in death from lung cancer in theoestrogen plus progestin group compared with placebo [13] . Also, an early cohort study showed reduced survival with prior HRT use inpatients with lung cancer [14] but this was not replicated in two later studies [15, 16] . Few epidemiological studies have investigated HRT use after cancer diagnosis and cancer-speciﬁc mortality, and to the best of our knowledge none has investigated HRT use after a bladder, gastric or

FAQs

Why was this study conducted?

Evidence on the safety of hormone replacement therapy (HRT) in women with cancer was limited, and clinicians faced uncertainty about how HRT might affect cancer outcomes.

How were participants and cancer diagnoses identified?

Women newly diagnosed with 17 site-specific cancers from 1998 to 2019 were identified using general practitioner records, hospital diagnoses, and cancer registries in Scotland, Wales, and England.

What was the main outcome and how was it analyzed?

The primary outcome was time to cancer-specific mortality. Time-dependent Cox regression models estimated adjusted hazard ratios with 95% confidence intervals for systemic HRT use.

Sep 21, 2026

Uploaded by Oliver