Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.
Cancer Control and Population Sciences, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, USA.
Thorax. 2024 Sep 18;79(10):961-969. doi: 10.1136/thorax-2023-220956.
Early natural menopause (early-M; <45 years of age) increases the risk of lung morbidities and mortalities in smokers. However, it is largely unknown whether early-M due to surgery demonstrates similar effects and whether menopausal hormone therapy (MHT) is protective against lung diseases.
To assess the associations of early-M and MHT with lung morbidities and mortalities using the prospective Prostate, Lung, Colorectal and Ovarian (PLCO) trial.
We estimated the risk among 69 706 postmenopausal women in the PLCO trial, stratified by menopausal types and smoking status.
Early-M was associated with an increased risk of most lung disease and mortality outcomes in ever smokers with the highest risk seen for respiratory mortality (HR 1.98, 95% CI 1.34 to 2.92) in those with bilateral oophorectomy (BO). Early-M was positively associated with chronic bronchitis, and all-cause, non-cancer and respiratory mortality in never smokers with natural menopause or BO, with the highest risk seen for BO- respiratory mortality (HR 1.91, 95% CI 1.16 to 3.12). Ever MHT was associated with reduced all-cause, non-cancer and cardiovascular mortality across menopause types regardless of smoking status and was additionally associated with reduced risk of non-ovarian cancer, lung cancer (LC) and respiratory mortality in ever smokers. Among smokers, ever MHT use was associated with a reduction in HR for all-cause, non-cancer and cardiovascular mortality in a duration-dependent manner.
Smokers with early-M should be targeted for smoking cessation and LC screening regardless of menopause types. MHT users had a lower likelihood of dying from LC and respiratory diseases in ever smokers.
早期自然绝经（绝经年龄<45 岁）会增加吸烟者肺部疾病发病率和死亡率。然而，由于手术导致的早期绝经是否具有相似影响，以及绝经激素治疗（MHT）是否对肺部疾病具有保护作用，在很大程度上尚不清楚。
使用前瞻性前列腺癌、肺癌、结直肠癌和卵巢癌（PLCO）试验，评估因手术导致的早期绝经和 MHT 与肺部疾病发病率和死亡率的相关性。
我们在 PLCO 试验中对 69706 名绝经后女性进行分层，根据绝经类型和吸烟状况评估风险。
在所有吸烟者中，早期绝经与大多数肺部疾病和死亡率结局的风险增加相关，双侧卵巢切除术（BO）者的呼吸死亡率风险最高（HR 1.98，95%CI 1.34 至 2.92）。在从未吸烟者中，自然绝经或 BO 后，早期绝经与慢性支气管炎、全因、非癌症和呼吸死亡率呈正相关，BO 与呼吸死亡率的相关性最高（HR 1.91，95%CI 1.16 至 3.12）。无论吸烟状况如何，MHT 始终与全因、非癌症和心血管死亡率的降低相关，并且与绝经后女性的非卵巢癌、肺癌（LC）和呼吸死亡率的降低相关。在吸烟者中，MHT 的使用与全因、非癌症和心血管死亡率的 HR 呈剂量依赖性降低相关。
无论绝经类型如何，都应针对有吸烟史的早期绝经患者进行戒烟和 LC 筛查。MHT 使用者在所有吸烟者中死于 LC 和呼吸疾病的可能性较低。
