Antiestrogen use reduces risk of cervical neoplasia in breast cancer patients: a population-based study

// Chia-Jung Hsieh 1,* , Mun-Kun Hong 2,3,* , Pau-Chung Chen 4,5,6 , Jen-Hung Wang 7 and Tang-Yuan Chu 2,3 1 Department of Public Health, Tzu Chi University, Hualien, Taiwan, ROC 2 Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, ROC 3 Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan, ROC 4 Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan, ROC 5 Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan, ROC 6 Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, ROC 7 Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, ROC * These authors have contributed equally to this work Correspondence to: Tang-Yuan Chu, email: // Keywords : cervical neoplasia, antiestrogen, aromatase inhibitor, tamoxifen, cervical cancer Received : August 15, 2016 Accepted : October 17, 2016 Published : October 27, 2016 Abstract Estrogen has been proven to be a necessity for cervical carcinogenesis by transgenic mice studies. To determine whether long-term antiestrogens use could reduce the incidence of cervical neoplasia, a population-based cohort of 42,940 breast cancer patients with and without antiestrogen therapy were identified from the Taiwan National Health Insurance Database. All patients were followed for the most severe form of cervical neoplasia or until death. Their risks of cervical neoplasia were compared with Cox regression analysis and adjusted for age, Pap smear density and chemotherapy. Aromatase inhibitor (AI)-included antiestrogen users consistently exhibited a lower risk of low-grade cervical dysplasia [adjusted hazard ratio (HR) = 0 . 42 , 95 % CI 0 . 29 to 0 . 64 , P < 0 . 0001 ] in the five-year follow-up analysis and in subgroup of regular Pap screenings (HR = 0.32, 95% CI, 0.20 to 0.50, P < 0.0001). A lower 10-year incidence of high-grade cervical dysplasia was also noted in the regular-screening group (HR = 0.49; 95% CI, 0.27 to 0.90; P = 0.0212), especially in the ≥ 50 years old group (HR = 0.34; 95% CI, 0.14 to 0.80; P = 0.014). The protection effect of Tamoxifen-only use for low-grade cervical dysplasia was only found in the young-age, regular-screening group (HR = 0.67; 95% CI, 0.48 to 0.93; P = 0.0167).In short, long-term use of AI-included antiestrogen conferred a lower risk of cervical neoplasia.