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Epidemiology
Postmenopausal hormone therapy may raise risk of meningioma
Last Updated: 2008-02-07 13:55:02 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Hormone replacement therapy (HRT) appears to be associated with the occurrence of meningioma, investigators at the Mayo Clinic in Jacksonville, Florida, report in the January 10th issue of the Journal of Clinical Oncology.
"I became interested in this subject when our Southwest Oncology Group found that tamoxifen (an estrogen blocker) showed modest evidence of efficacy in delaying meningioma growth in some individuals," Dr. Kurt A. Jaeckle told Reuters Health.
Multiple lines of evidence link meningioma with female hormones, the researcher added, including expression of estrogen and progesterone receptors and higher incidence in women and in patients with breast cancer.
"So there is a logical, albeit unproven, connection," he said.
To investigate the relationship between a diagnosis of meningioma and HRT use, Dr. Jaeckle's team reviewed records for the 355,318 women ages 26 to 86 years treated at their clinic between 1993 and 2003. Of these, 18,037 were current or past users of HRT.
They identified 1390 patients with a history of either symptomatic meningioma or clinically silent meningioma incidentally discovered on brain MRI.
Overall, the prevalence of meningioma was 865 per 100,000 in HRT users and 366 per 100,000 in nonusers (adjusted odds ratio 2.2, p < .0001). The association appeared to be stronger among younger women, with an odds ratio of 4.1 for those aged 26 to 55 years.
For now, this issue is just one of many that the physician should consider in weighing the potential benefits and risks of HRT, Dr. Jaeckle advised.
That said, important questions remain to be answered. "If a woman has an 'atypical' malignant or recurrent meningioma and is on HRT, should the HRT be stopped (or not started)? Do any of the benign meningiomas convert to more fast growing tumors if a patient is on HRT?"
Dr. Jaeckle and his associates are actively pursuing answers. "We are planning laboratory studies (eg, gene microarray analysis) to try to identify genetic profiles that predispose women to develop these tumors -- and ideally, whether particular gene patterns would identify women in whom oral contraceptives and HRT should be avoided -- presuming there is a cause-and-effect relationship."
Until there is direct evidence of a link between HRT and a more malignant profile, he concluded, "I want to reassure women that in the absence of this information there is no call for alarm."
J Clin Oncol 2008;26:279-282.