{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T20:12:25Z","timestamp":1789589545908,"version":"build-2803163510"},"reference-count":19,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"30","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO"],"published-print":{"date-parts":[[2024,10,20]]},"abstract":"<jats:p>\n            <jats:italic>Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in<\/jats:italic>\n            JCO\n            <jats:italic>or elsewhere, for which the primary end point has already been reported.<\/jats:italic>\n          <\/jats:p>\n          <jats:p>\n            We report long-term colorectal cancer findings from the Women's Health Initiative trial where 16,608 postmenopausal women with a uterus were randomly assigned to daily conjugated equine estrogen (CEE) 0.625 mg, plus medroxyprogesterone acetate (MPA) 2.5 mg, or placebo. When intervention ended after 5.6 years, although there were 44% fewer colorectal cancers in the intervention group (43\n            <jats:italic>v<\/jats:italic>\n            72,\n            <jats:italic>P<\/jats:italic>\n            = .003), the cancers were more commonly lymph node\u2013positive (59.0%\n            <jats:italic>v<\/jats:italic>\n            29.4%,\n            <jats:italic>P<\/jats:italic>\n            = .003). Now after cumulative 24-year follow-up, with 431 colorectal cancers, CEE plus MPA no longer influenced colorectal cancer incidence (215 [0.15, annualized rate %]\n            <jats:italic>v<\/jats:italic>\n            216 [0.15], hazard ratio [HR], 0.95 [95% CI, 0.79 to 1.15]). Although not statistically significant, there were more colorectal cancer deaths with CEE plus MPA (87 [0.049]\n            <jats:italic>v<\/jats:italic>\n            69 [0.041] deaths, HR, 1.20 [95% CI, 0.87 to 1.65],\n            <jats:italic>P<\/jats:italic>\n            = .26). Vaginal bleeding (54.1%\n            <jats:italic>v<\/jats:italic>\n            5.2% at 6 months) and breast changes were more frequent in the intervention group. After adjusting for postrandomization vaginal bleeding and breast changes, bowel examinations were significantly delayed in intervention group participants (\n            <jats:italic>P<\/jats:italic>\n            = .005), potentially contributing to diagnostic delay. Taken together, the findings suggest no clinically meaningful benefit for about 5 years of CEE plus MPA use on colorectal cancer outcome.\n          <\/jats:p>","DOI":"10.1200\/jco.23.02092","type":"journal-article","created":{"date-parts":[[2024,7,19]],"date-time":"2024-07-19T20:02:10Z","timestamp":1721419330000},"page":"3530-3536","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":7,"title":["Estrogen Plus Progestin and Colorectal Cancer: Long-Term Findings From the Women's Health Initiative Randomized Clinical Trial"],"prefix":"10.1200","volume":"42","clinical-trial-number":[{"clinical-trial-number":"nct00000611","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4212-6184","authenticated-orcid":false,"given":"Rowan T.","family":"Chlebowski","sequence":"first","affiliation":[{"name":"The Lundquist Institute, Torrance, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron K.","family":"Aragaki","sequence":"additional","affiliation":[{"name":"Fred Hutchinson Cancer Center, Seattle, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3546-2566","authenticated-orcid":false,"given":"Kathy","family":"Pan","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Southern California, Downey, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8901-4462","authenticated-orcid":false,"given":"Juhua","family":"Luo","sequence":"additional","affiliation":[{"name":"University of Indiana, Bloomington, IN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas E.","family":"Rohan","sequence":"additional","affiliation":[{"name":"Albert Einstein College of Medicine, Bronx, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3493-4077","authenticated-orcid":false,"given":"Karen C.","family":"Johnson","sequence":"additional","affiliation":[{"name":"University of Tennessee Health Science Center, Memphis, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3096-9595","authenticated-orcid":false,"given":"Jean","family":"Wactawski-Wende","sequence":"additional","affiliation":[{"name":"University at Buffalo, Buffalo, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0513-1830","authenticated-orcid":false,"given":"Su Yon","family":"Jung","sequence":"additional","affiliation":[{"name":"Jonsson Comprehensive Cancer Center, Los Angeles, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8388-1178","authenticated-orcid":false,"given":"Qian","family":"Xiao","sequence":"additional","affiliation":[{"name":"The University of Texas Health Science Center at Houston School of Public Health, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sayeh","family":"Lavasani","sequence":"additional","affiliation":[{"name":"City of Hope National Medical Center, Duarte, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JoAnn E.","family":"Manson","sequence":"additional","affiliation":[{"name":"Brigham and Women's Hospital, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3237-6761","authenticated-orcid":false,"given":"Michael S.","family":"Simon","sequence":"additional","affiliation":[{"name":"Barbara Ann Karmanos Cancer Institute, Detroit, MI"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2005.09.059"},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa032071"},{"key":"e_1_3_7_4_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2012.42.7732"},{"key":"e_1_3_7_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.278040"},{"key":"e_1_3_7_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.11217"},{"key":"e_1_3_7_7_2","first-page":"CD004143","article-title":"Long-term hormone therapy for perimenopausal and postmenopausal women","volume":"1","author":"Marjoribanks J","year":"2017","unstructured":"Marjoribanks J, Farquhar C, Roberts H, et al: Long-term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev 1:CD004143, 2017","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_3_7_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12253-018-00569-x"},{"key":"e_1_3_7_9_2","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2021.564781"},{"key":"e_1_3_7_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/GME.0000000000002028"},{"key":"e_1_3_7_11_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.291.14.1701"},{"key":"e_1_3_7_12_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.288.3.321"},{"key":"e_1_3_7_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.294.2.183"},{"key":"e_1_3_7_14_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.9482"},{"key":"e_1_3_7_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0b013e3181c1ea43"},{"key":"e_1_3_7_16_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.3676"},{"key":"e_1_3_7_17_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.289.24.3243"},{"key":"e_1_3_7_18_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2007.123"},{"key":"e_1_3_7_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djx001"},{"key":"e_1_3_7_20_2","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-08-0385"}],"container-title":["Journal of Clinical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascopubs.org\/doi\/pdfdirect\/10.1200\/JCO.23.02092","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,25]],"date-time":"2024-10-25T17:07:34Z","timestamp":1729876054000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascopubs.org\/doi\/10.1200\/JCO.23.02092"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,20]]},"references-count":19,"journal-issue":{"issue":"30","published-print":{"date-parts":[[2024,10,20]]}},"alternative-id":["10.1200\/JCO.23.02092"],"URL":"https:\/\/doi.org\/10.1200\/jco.23.02092","relation":{},"ISSN":["0732-183X","1527-7755"],"issn-type":[{"value":"0732-183X","type":"print"},{"value":"1527-7755","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,20]]},"assertion":[{"value":"2023-09-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-21","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-05-01","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-07-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}