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Association of menopausal hormone therapy with gastric and colorectal cancer risks in Korean women: A nationwide population-based cohort study

  • Author Footnotes
    1 These authors contributed equally to this work.
    Chaewon Baek
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Northeastern University Bouvé College of Health Sciences School of Pharmacy, Boston, MA, USA
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Ji-Eun Kim
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea
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  • Aesun Shin
    Affiliations
    Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea

    Cancer Research Institute, Seoul National University, Seoul, South Korea

    Department of Innovative Medical Science, Seoul National University College of Medicine, Seoul, South Korea
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  • Ji-Yeob Choi
    Correspondence
    Corresponding author at: Department of Biomedical Sciences, Seoul National University Graduate School, 103 Daehak-ro, Jongno-gu, Seoul 03080, South Korea.
    Affiliations
    Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, South Korea

    Cancer Research Institute, Seoul National University, Seoul, South Korea

    Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, South Korea
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  • Author Footnotes
    1 These authors contributed equally to this work.

      Highlights

      • This study investigated whether the use of menopausal hormone therapy is associated with the risks of gastric and colorectal cancer in Korean women using the National Health Insurance Service–National Sample Cohort (NHIS-NSC) version 2.0.
      • The use of estrogen replacement therapy was inversely associated with risks of gastric and colorectal cancer.
      • Our findings may support the protective association between estrogen and gastric and colorectal cancer in Korean women.

      Abstract

      Background

      Menopausal hormone therapy (MHT) has been associated with a decreased risk of gastric cancer (GC) and colorectal cancer (CRC); however, few studies have been conducted in diverse ethnic groups, particularly in the Asian population. Therefore, the current study evaluated if MHT is inversely associated with GC and CRC in East Asia using a representative population-based study in Korea.

      Methods

      This retrospective cohort study was conducted using the National Health Insurance Service–National Sample Cohort 2.0 in South Korea from 2002 to 2015. A total of 196,095 women aged ≥40 years were included in the study. The numbers of participants who did and did not use MHT were 19,063 (9.7 %) and 177,032 (90.3 %), respectively. Hazard ratios (HRs) and the corresponding 95 % confidence intervals (CIs) were estimated using a time-dependent Cox proportional hazards model. Age was considered as a time scale, and other confounding factors, including income levels based on insurance premiums, region of residence, and comorbidities, were included in the multivariable-adjusted model.

      Results

      The total number of incident cases of GC and CRC were 1339 (0.68 %) and 1428 (0.73 %), respectively. We observed an inverse association of the use of estrogen replacement therapy (ERT; estrogen-containing therapy regardless of other regimen types) with GC [HR (95 % CI):0.68 (0.51–0.90)], CRC [0.57 (0.42–0.78)] and gastrointestinal cancer [GI, 0.63 (0.51–0.77)]. In the analyses by CRC subsite, the risks of both colon and rectal cancers were associated with ERT. In addition, both estrogen and combined estrogen and progestogen regimens were significantly associated with CRC and GI cancer.

      Conclusion

      ERT was associated with a decreased risk of GC and CRC. Our findings support the protective effect of estrogen against GC and CRC in Korean women.

      Keywords

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