In The Lancet today, Rowan Chlebowski and colleagues1 present a post-hoc analysis of the Women's Health Initiative's study that evaluated the effects of combined hormone-replacement therapy on lung cancer incidence and mortality in postmenopausal women. The investigators had randomised more than 16500 postmenopausal women to placebo or a combination of conjugated equine oestrogen and medroxyprogesterone acetate. In this analysis, they found that women in the treatment arm had a nonsignificant increase in the incidence of lung cancer. These women were also more likely to have increased mortality from lung cancer (hazard ratio 1.71, 95% Cl 1.16-2.52), more specifically non-small-cell lung cancer. Another interesting aspect was that women who received hormone therapy were more likely to have poorly differentiated and metastatic tumours. Thus hormone replacement possibly leads to the development of more aggressive lung cancers and decreases survival in patients who have developed lung cancer.
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