title: Menopausal hormone therapy and mortality among endometrial cancer patients in the NIH-AARP Diet and Health Study.
abstract: BACKGROUND
  While menopausal hormone therapy (MHT) is an established endometrial cancer risk factor, its relationship with mortality among endometrial cancer patients is understudied.
  
  
  METHODS
  Within the NIH-AARP Diet and Health Study, we examined the associations of pre-diagnosis MHT use with 10-year all-cause and endometrial cancer-specific mortality among 890 endometrial cancer patients. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) adjusted for tumor characteristics, treatment, and other risk factors.
  
  
  RESULTS
  Endometrial cancer cases were diagnosed a median of 4.6 years (range 0.0-10.1 years) after the second risk factor questionnaire was completed. We identified a total of 241 deaths, of which 104 were due to endometrial cancer. Compared with non-MHT use, pre-diagnosis use of estrogen plus progestin therapy (EPT)-only was associated with lower 10-year all-cause (HR 0.65, 95 % CI 0.43-0.99, based on 29 deaths) and endometrial cancer-specific mortality (HR 0.51, 95 % CI 0.26-0.98, based on 11 deaths). Recency of MHT use, assessed approximately 5 years prior to the endometrial cancer diagnosis, was associated with mortality. Compared with non-MHT users, former ET users had higher all-cause (HR 1.71, 95 % CI 1.02-2.88, based on 18 deaths) and endometrial cancer-specific mortality (HR 2.17, 95 % CI 0.96-4.90, based on 8 deaths), whereas current EPT users had nonsignificant lower risks of death.
  
  
  CONCLUSIONS
  Based on small numbers, we observed that pre-diagnosis use of EPT was related to lower mortality among endometrial cancer patients. Future studies examining the biological mechanisms underlying this association are warranted.
authors.affiliation: Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, Room 7E214, Bethesda, MD, 20892-9774, USA, ashley.felix@nih.gov.
authors.forename: Ashley S
authors.initials: AS
authors.lastname: Felix
authors.forename: Hannah
authors.initials: H
authors.lastname: Arem
authors.forename: Britton
authors.initials: B
authors.lastname: Trabert
authors.forename: Gretchen L
authors.initials: GL
authors.lastname: Gierach
authors.forename: Yikyung
authors.initials: Y
authors.lastname: Park
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Pfeiffer
authors.forename: Louise A
authors.initials: LA
authors.lastname: Brinton
mesh_terms: D000368:Aged; D016889:Endometrial Neoplasms / Q000175:diagnosis / Q000401:mortality*; D004967:Estrogens / Q000008:administration & dosage; D005260:Female; D020249:Hormone Replacement Therapy / Q000009:adverse effects; D006801:Humans; D008593:Menopause; D008875:Middle Aged; D011372:Progestins / Q000008:administration & dosage; D016016:Proportional Hazards Models; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
chemical_list: D004967:Estrogens; D011372:Progestins