Hormone Therapy in Relation to Risks of Second Cancers and Mortality Among Women and Men

Date of Approval: 
2016-08-23 00:00:00
Lay Summary: 
Men are approximately 50% more likely to be diagnosed with cancer and approximately 70% more likely to die from cancer, compared with women. In addition to established risk factors that differ by sex, such as smoking and obesity, sex hormones may explain part of the excess of cancer in men but little evidence exists. To examine this, we propose to assess hormone therapy, including medications and surgical procedures, commonly used to treat breast and prostate cancers, in relation to risks of subsequent cancers and deaths. Thus, we will study two groups of patients- a breast cancer group and a prostate cancer group- and compare individuals who have used hormone therapies with those that have not used hormone therapies. In an attempt to make sure that differences between the individuals using therapy and those not using therapy can be attributed to the therapy, we will account for various factors such as breast and prostate cancer characteristics, obesity, smoking, and alcohol consumption. This study will help to clarify how hormones are associated with cancer risk in both men and women and provide evidence to weight risks and benefits of hormonal therapies in breast and prostate cancer patients.
Technical Summary: 
Men experience ~50% more cancer incidence and ~70% more cancer-related mortality, compared with women. In addition to established risk factors that differ in prevalence by sex, such as smoking and obesity, sex hormones have been hypothesized to explain part of excessive cancer risks in men but little epidemiological evidence exists. To further understand the influence of hormones on cancer risk, we propose to assess the use of hormone therapy, commonly used to treat breast and prostate cancers, in relation to risks of second cancers and deaths. We propose to construct a female breast cancer cohort and male prostate cancer cohort. The exposure of interest will be anti-estrogens and androgen deprivation therapy (ADT), respectively. Hormone therapy includes medication use and surgical procedures after a first primary breast cancer or first primary prostate cancer diagnosis. Cox proportional hazards regression will be used to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (95%CIs) for the associations of hormone therapy in relation to risks of second primary cancer and mortality. Propensity scores will be used to control for potential confounding. The proposed study will substantially add to the literature on our understanding of how sex steroid hormones are associated with risks of second cancer and mortality.
Health Outcomes to be Measured: 
Incident second primary malignant cancer, and disease-specific (e.g., prostate/breast cancer-specific mortality and deaths by organ system), and all-cause mortality using the underlying cause of death in ONS mortality data.
Application Number: 
16_148
Collaborators: 

Michael Cook - Chief Investigator - National Cancer Institute ( NCI )
Barry I Graubard - Collaborator - National Cancer Institute ( NCI )
Cher Dallal - Collaborator - University Of Maryland
Cindy Zhou - Collaborator - National Cancer Institute ( NCI )
Gretchen L Gierach - Collaborator - National Cancer Institute ( NCI )
Jessica Petrick - Collaborator - National Cancer Institute ( NCI )
Liam Murray - Collaborator - Queen's University Belfast
Maeve Mullooly - Collaborator - National Cancer Institute ( NCI )
Marie Bradley - Collaborator - Food and Drug Administration - FDA
Rajrupa Ghosh - Collaborator - National Cancer Institute ( NCI )
Úna McMenamin - Collaborator - Queen's University Belfast

Linkages: 
HES Admitted Patient Care;NCRAS Cancer Registration Data;ONS Death Registration Data;Patient Level Townsend Score