Ovarian cancer incidence trends in relation to changing patterns of menopausal hormone therapy use in the United States

Hannah P. Yang, William F. Anderson, Philip S. Rosenberg, Britton Trabert, Gretchen L. Gierach, Nicolas Wentzensen, Kathleen A. Cronin, Mark E. Sherman

Research output: Contribution to journalArticle

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Abstract

Purpose: After a report from the Women’s Health Initiative (WHI) in 2002, a precipitous decline in menopausal hormonal therapy (MHT) use in the United States was linked to a decline in breast cancer incidence rates. Given that MHT use is also associated with increased ovarian cancer risk, we tested whether ovarian cancer incidence rates changed after 2002. Methods: Using the North American Association of Central Cancer Registries database (1995 to 2008; N 171,142 incident ovarian cancers), we applied standard analytic approaches and age-period-cohort (APC) models to estimate ovarian cancer incidence rate changes before (1995 to 2002) and after (2003 to 2008) the WHI report. Results: Among women age 50 years, age-standardized ovarian cancer incidence declined by 0.8% per year (95% CI, 1.8% to 0.5% per year) before the WHI announcement; after the WHI report, the rate declined by 2.4% per year (95% CI, 2.5% to 2.2% per year). APC models confirmed an accelerated decline in ovarian cancer incidence after the WHI report, adjusted for age and birth cohort effects. This sudden change was notable among women most likely to have used MHT (ie, women age 50 to 69 years, white women, and residents of regions with highest MHT prescription frequency). The largest changes were found for the endometrioid histologic subtype. Conclusion: After a marked reduction in MHT use around 2002, ovarian cancer incidence rates demonstrated an accelerated decline, with the largest changes for endometrioid carcinomas. This strong temporal association, although not proving a causal role of hormones in ovarian carcinogenesis, suggests that future analytic research supporting cancer control efforts should clarify the role of hormonal exposures on the development and behavior of subtypes of ovarian cancer.

Original languageEnglish (US)
Pages (from-to)2146-2151
Number of pages6
JournalJournal of Clinical Oncology
Volume31
Issue number17
DOIs
StatePublished - Jun 10 2013

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Ovarian Neoplasms
Hormones
Women's Health
Incidence
Therapeutics
Endometrioid Carcinoma
Cohort Effect
Prescriptions
Registries
Neoplasms
Carcinogenesis
Parturition
Databases
Breast Neoplasms
Research

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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Ovarian cancer incidence trends in relation to changing patterns of menopausal hormone therapy use in the United States. / Yang, Hannah P.; Anderson, William F.; Rosenberg, Philip S.; Trabert, Britton; Gierach, Gretchen L.; Wentzensen, Nicolas; Cronin, Kathleen A.; Sherman, Mark E.

In: Journal of Clinical Oncology, Vol. 31, No. 17, 10.06.2013, p. 2146-2151.

Research output: Contribution to journalArticle

Yang, HP, Anderson, WF, Rosenberg, PS, Trabert, B, Gierach, GL, Wentzensen, N, Cronin, KA & Sherman, ME 2013, 'Ovarian cancer incidence trends in relation to changing patterns of menopausal hormone therapy use in the United States', Journal of Clinical Oncology, vol. 31, no. 17, pp. 2146-2151. https://doi.org/10.1200/JCO.2012.45.5758
Yang, Hannah P. ; Anderson, William F. ; Rosenberg, Philip S. ; Trabert, Britton ; Gierach, Gretchen L. ; Wentzensen, Nicolas ; Cronin, Kathleen A. ; Sherman, Mark E. / Ovarian cancer incidence trends in relation to changing patterns of menopausal hormone therapy use in the United States. In: Journal of Clinical Oncology. 2013 ; Vol. 31, No. 17. pp. 2146-2151.
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AU - Anderson, William F.

AU - Rosenberg, Philip S.

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AU - Gierach, Gretchen L.

AU - Wentzensen, Nicolas

AU - Cronin, Kathleen A.

AU - Sherman, Mark E.

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N2 - Purpose: After a report from the Women’s Health Initiative (WHI) in 2002, a precipitous decline in menopausal hormonal therapy (MHT) use in the United States was linked to a decline in breast cancer incidence rates. Given that MHT use is also associated with increased ovarian cancer risk, we tested whether ovarian cancer incidence rates changed after 2002. Methods: Using the North American Association of Central Cancer Registries database (1995 to 2008; N 171,142 incident ovarian cancers), we applied standard analytic approaches and age-period-cohort (APC) models to estimate ovarian cancer incidence rate changes before (1995 to 2002) and after (2003 to 2008) the WHI report. Results: Among women age 50 years, age-standardized ovarian cancer incidence declined by 0.8% per year (95% CI, 1.8% to 0.5% per year) before the WHI announcement; after the WHI report, the rate declined by 2.4% per year (95% CI, 2.5% to 2.2% per year). APC models confirmed an accelerated decline in ovarian cancer incidence after the WHI report, adjusted for age and birth cohort effects. This sudden change was notable among women most likely to have used MHT (ie, women age 50 to 69 years, white women, and residents of regions with highest MHT prescription frequency). The largest changes were found for the endometrioid histologic subtype. Conclusion: After a marked reduction in MHT use around 2002, ovarian cancer incidence rates demonstrated an accelerated decline, with the largest changes for endometrioid carcinomas. This strong temporal association, although not proving a causal role of hormones in ovarian carcinogenesis, suggests that future analytic research supporting cancer control efforts should clarify the role of hormonal exposures on the development and behavior of subtypes of ovarian cancer.

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