Evidence map›Paper›PMID 26668177›Full record

Trial reportJournal of the National Cancer Institute2016

Continuous Combined Estrogen Plus Progestin and Endometrial Cancer: The Women's Health Initiative Randomized Trial.

R T Chlebowski, G L Anderson, G E Sarto, R Haque, C D Runowicz, A K Aragaki, C A Thomson, B V Howard, J Wactawski-Wende, C Chen and 4 more

Open access · bronzeAbstract readRandomized Controlled Trial
In one paragraph

Trial report in Journal of the National Cancer Institute, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
39citing papers in PubMed, 3 pooled it
9.4field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

39 citing papers in PubMed, 3 syntheses or guidelines pooled it, 95 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Long-term hormone therapy for perimenopausal and postmenopausal women.The Cochrane database of systematic reviews · 2017
    Pooled it
  4. Trial
  5. Article
  6. Review
  7. Then and Now: What We Have Learned From the WHI.The Journal of clinical endocrinology and metabolism · 2026
    Review
  8. Review
  9. Article
  10. Review
  11. Review
  12. Predictive Genetic Testing in the Cancer Management and Prevention.Journal of cancer science and clinical therapeutics · 2025
    Article
  13. Article
  14. Article
  15. Article
  16. Risk assessment for endometrial cancer in women with abnormal vaginal bleeding: Results from the prospective IETA-1 cohort study.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2022
    Observational
  17. Article
  18. Article
  19. Article
  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors at 10 institutions in 1 country.

R T ChlebowskiAffiliations of authors: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA (RTC); Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA (GLA, AKA, CC ); Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA (GES, SDR); Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA (RH); Herbert Wertheim College of Medicine Florida International University, Miami, FL (CDR); Department of Nutritional Sciences and Arizona Cancer Center, University of Arizona, Tucson, AZ (CAT); Star Research Institute / Howard University, Washington, DC (BVH); Department of Social and Preventive Medicine, State University of New York, Memphis, TN (JWW); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER); Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI (MSS); Brigham and Women's Health Hospital, Harvard Medical School, Boston, MA (JEM) rowanchlebowski@gmail.com.
G L AndersonAffiliations of authors: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA (RTC); Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA (GLA, AKA, CC ); Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA (GES, SDR); Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA (RH); Herbert Wertheim College of Medicine Florida International University, Miami, FL (CDR); Department of Nutritional Sciences and Arizona Cancer Center, University of Arizona, Tucson, AZ (CAT); Star Research Institute / Howard University, Washington, DC (BVH); Department of Social and Preventive Medicine, State University of New York, Memphis, TN (JWW); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER); Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI (MSS); Brigham and Women's Health Hospital, Harvard Medical School, Boston, MA (JEM).
G E SartoAffiliations of authors: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA (RTC); Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA (GLA, AKA, CC ); Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA (GES, SDR); Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA (RH); Herbert Wertheim College of Medicine Florida International University, Miami, FL (CDR); Department of Nutritional Sciences and Arizona Cancer Center, University of Arizona, Tucson, AZ (CAT); Star Research Institute / Howard University, Washington, DC (BVH); Department of Social and Preventive Medicine, State University of New York, Memphis, TN (JWW); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER); Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI (MSS); Brigham and Women's Health Hospital, Harvard Medical School, Boston, MA (JEM).
R HaqueAffiliations of authors: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA (RTC); Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA (GLA, AKA, CC ); Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA (GES, SDR); Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA (RH); Herbert Wertheim College of Medicine Florida International University, Miami, FL (CDR); Department of Nutritional Sciences and Arizona Cancer Center, University of Arizona, Tucson, AZ (CAT); Star Research Institute / Howard University, Washington, DC (BVH); Department of Social and Preventive Medicine, State University of New York, Memphis, TN (JWW); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER); Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI (MSS); Brigham and Women's Health Hospital, Harvard Medical School, Boston, MA (JEM).
C D RunowiczAffiliations of authors: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA (RTC); Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA (GLA, AKA, CC ); Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA (GES, SDR); Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA (RH); Herbert Wertheim College of Medicine Florida International University, Miami, FL (CDR); Department of Nutritional Sciences and Arizona Cancer Center, University of Arizona, Tucson, AZ (CAT); Star Research Institute / Howard University, Washington, DC (BVH); Department of Social and Preventive Medicine, State University of New York, Memphis, TN (JWW); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER); Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI (MSS); Brigham and Women's Health Hospital, Harvard Medical School, Boston, MA (JEM).
A K AragakiAffiliations of authors: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA (RTC); Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA (GLA, AKA, CC ); Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA (GES, SDR); Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA (RH); Herbert Wertheim College of Medicine Florida International University, Miami, FL (CDR); Department of Nutritional Sciences and Arizona Cancer Center, University of Arizona, Tucson, AZ (CAT); Star Research Institute / Howard University, Washington, DC (BVH); Department of Social and Preventive Medicine, State University of New York, Memphis, TN (JWW); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER); Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI (MSS); Brigham and Women's Health Hospital, Harvard Medical School, Boston, MA (JEM).
C A ThomsonAffiliations of authors: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA (RTC); Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA (GLA, AKA, CC ); Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA (GES, SDR); Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA (RH); Herbert Wertheim College of Medicine Florida International University, Miami, FL (CDR); Department of Nutritional Sciences and Arizona Cancer Center, University of Arizona, Tucson, AZ (CAT); Star Research Institute / Howard University, Washington, DC (BVH); Department of Social and Preventive Medicine, State University of New York, Memphis, TN (JWW); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER); Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI (MSS); Brigham and Women's Health Hospital, Harvard Medical School, Boston, MA (JEM).
B V HowardAffiliations of authors: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA (RTC); Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA (GLA, AKA, CC ); Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA (GES, SDR); Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA (RH); Herbert Wertheim College of Medicine Florida International University, Miami, FL (CDR); Department of Nutritional Sciences and Arizona Cancer Center, University of Arizona, Tucson, AZ (CAT); Star Research Institute / Howard University, Washington, DC (BVH); Department of Social and Preventive Medicine, State University of New York, Memphis, TN (JWW); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER); Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI (MSS); Brigham and Women's Health Hospital, Harvard Medical School, Boston, MA (JEM).
J Wactawski-WendeAffiliations of authors: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA (RTC); Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA (GLA, AKA, CC ); Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA (GES, SDR); Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA (RH); Herbert Wertheim College of Medicine Florida International University, Miami, FL (CDR); Department of Nutritional Sciences and Arizona Cancer Center, University of Arizona, Tucson, AZ (CAT); Star Research Institute / Howard University, Washington, DC (BVH); Department of Social and Preventive Medicine, State University of New York, Memphis, TN (JWW); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER); Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI (MSS); Brigham and Women's Health Hospital, Harvard Medical School, Boston, MA (JEM).
C ChenAffiliations of authors: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA (RTC); Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA (GLA, AKA, CC ); Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA (GES, SDR); Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA (RH); Herbert Wertheim College of Medicine Florida International University, Miami, FL (CDR); Department of Nutritional Sciences and Arizona Cancer Center, University of Arizona, Tucson, AZ (CAT); Star Research Institute / Howard University, Washington, DC (BVH); Department of Social and Preventive Medicine, State University of New York, Memphis, TN (JWW); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER); Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI (MSS); Brigham and Women's Health Hospital, Harvard Medical School, Boston, MA (JEM).
T E RohanAffiliations of authors: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA (RTC); Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA (GLA, AKA, CC ); Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA (GES, SDR); Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA (RH); Herbert Wertheim College of Medicine Florida International University, Miami, FL (CDR); Department of Nutritional Sciences and Arizona Cancer Center, University of Arizona, Tucson, AZ (CAT); Star Research Institute / Howard University, Washington, DC (BVH); Department of Social and Preventive Medicine, State University of New York, Memphis, TN (JWW); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER); Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI (MSS); Brigham and Women's Health Hospital, Harvard Medical School, Boston, MA (JEM).
M S SimonAffiliations of authors: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA (RTC); Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA (GLA, AKA, CC ); Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA (GES, SDR); Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA (RH); Herbert Wertheim College of Medicine Florida International University, Miami, FL (CDR); Department of Nutritional Sciences and Arizona Cancer Center, University of Arizona, Tucson, AZ (CAT); Star Research Institute / Howard University, Washington, DC (BVH); Department of Social and Preventive Medicine, State University of New York, Memphis, TN (JWW); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER); Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI (MSS); Brigham and Women's Health Hospital, Harvard Medical School, Boston, MA (JEM).
S D ReedAffiliations of authors: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA (RTC); Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA (GLA, AKA, CC ); Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA (GES, SDR); Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA (RH); Herbert Wertheim College of Medicine Florida International University, Miami, FL (CDR); Department of Nutritional Sciences and Arizona Cancer Center, University of Arizona, Tucson, AZ (CAT); Star Research Institute / Howard University, Washington, DC (BVH); Department of Social and Preventive Medicine, State University of New York, Memphis, TN (JWW); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER); Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI (MSS); Brigham and Women's Health Hospital, Harvard Medical School, Boston, MA (JEM).
J E MansonAffiliations of authors: Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA (RTC); Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA (GLA, AKA, CC ); Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA (GES, SDR); Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA (RH); Herbert Wertheim College of Medicine Florida International University, Miami, FL (CDR); Department of Nutritional Sciences and Arizona Cancer Center, University of Arizona, Tucson, AZ (CAT); Star Research Institute / Howard University, Washington, DC (BVH); Department of Social and Preventive Medicine, State University of New York, Memphis, TN (JWW); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER); Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI (MSS); Brigham and Women's Health Hospital, Harvard Medical School, Boston, MA (JEM).
University of Washington · USHarbor–UCLA Medical Center · USThe Lundquist Institute · USFlorida International University · USFred Hutch Cancer Center · USHarvard University · USHoward University · USLos Angeles Medical Center · USThe Barbara Ann Karmanos Cancer Institute · USWayne State University · US

Funding

Women's Health Initiative Clinical Coordinating CenterN01WH22110 · WH · FRED HUTCHINSON CANCER RESEARCH CENTER · PI PRENTICE, ROSS L · 2007 to 2010
$22.5M
Women's Health Initiative Memory Study (WHIMS)N01WH44221 · WH · WAKE FOREST UNIVERSITY HEALTH SCIENCES · 2009 to 2010
$3.1M
VANGUARD CENTER FOR WOMEN'S HEALTH INITIATIVEN01WH032111 · WH · EMORY UNIVERSITY · PI WATTS, NELSON · 1993 to 2001
$1.6M
WOMENS HEALTH INITIATIVE-N01WH22110N01WH022110 · WH · FRED HUTCHINSON CANCER RESEARCH CENTER · PI ROSS, PRENTICE · 1992 to 2006
$1.2M
VANGUARD CENTER FOR WOMEN'S HEALTH INITIATIVEN01WH032105 · WH · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI LEWIS, CORA E · 1993 to 2000
$1.2M
VANGUARD CENTER FOR WOMENS HEALTH INITIATIVEN01WH032100 · WH · FRED HUTCHINSON CANCER RESEARCH CENTER · PI BERESFORD, SHIRLEY AA · 1993 to 2001
$1.1M
VANGUARD CENTER FOR WOMEN'S HEALTH INITIATIVEN01WH032118 · WH · UNIVERSITY OF TENNESSEE HEALTH SCI CTR · PI JOHNSON, KAREN C · 1993 to 2000
$992k
VANGUARD CENTER FOR WOMEN'S HEALTH INITIATIVEN01WH032122 · WH · STATE UNIVERSITY OF NEW YORK AT BUFFALO · PI TREVISAN, MAURIZIO · 1993 to 2000
$927k
VANGUARD CENTER FOR WOMENS HEALTH INITIATIVEN01WH032108 · WH · NORTHWESTERN UNIVERSITY · PI GREENLAND, PHILIP · 1993 to 2000
$919k
CLIN CTR CLIN TRIAL/OBSERVATIONAL STUDY OF WHIN01WH042129 · WH · UNIVERSITY OF FLORIDA · PI LIMACHER, MARIAN C. · 1994 to 2000
$868k
Women's Health Initiative Field CenterN01WH24152 · WH · UNIV OF MED/DENT OF NJ-SCHOOL OF NURSING · PI LASSER, NORMAN · 2007 to 2009
$648k
Women's Health InitiativeN01WH32122 · WH · STATE UNIVERSITY OF NEW YORK AT BUFFALO · PI WACTAWSKI-WENDE, JEAN · 2008 to 2009
$609k
WHI NIH HHS N01WH22110WHI NIH HHS N01WH24152WHI NIH HHS N01WH32100-2WHI NIH HHS N01WH32105-6WHI NIH HHS N01WH32108-9WHI NIH HHS N01WH32111-13WHI NIH HHS N01WH32115WHI NIH HHS N01WH32118-2119WHI NIH HHS N01WH32122WHI NIH HHS N01WH42107-26WHI NIH HHS N01WH42129-32WHI NIH HHS N01WH44221
6 · The paper itself

Abstract

backgroundWhile progestin addition to estrogen mitigates endometrial cancer risk, the magnitude of the effect on incidence, specific endometrial cancer histologies, and endometrial cancer mortality remains unsettled. These issues were assessed by analyses after extended follow-up of the Women's Health Initiative (WHI) randomized clinical trial evaluating continuous combined estrogen plus progestin use.

methodsThe WHI enrolled 16 608 postmenopausal women into a randomly assigned, double-blind, placebo-controlled trial. Women age 50 to 79 years with intact uteri with normal endometrial biopsy at entry were randomly assigned to once-daily 0.625 mg conjugated equine estrogen plus 2.5mg medroxyprogesterone acetate (n = 8506) as a single pill or matching placebo (n = 8102). Follow-up beyond the original trial completion date required reconsent, obtained from 12 788 (83%) of surviving participants. Analyses were by intent-to-treat. All statistical tests were two-sided.

resultsAfter 5.6 years' median intervention and 13 years' median cumulative follow-up, there were fewer endometrial cancers in the combined hormone therapy compared with the placebo group (66 vs 95 case patients, yearly incidence, 0.06% vs 0.10%; hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.48 to 0.89, P = .007). While there were somewhat fewer endometrial cancers during intervention (25 vs 30, respectively; HR = 0.77, 95% CI = 0.45 to 1.31), the difference became statistically significant postintervention (41 vs 65, respectively; HR = 0.59, 95% CI = 0.40 to 0.88, P = .008), but hazard ratios did not differ between phases (P difference = .46). There was a statistically nonsignificant reduction in deaths from endometrial cancer in the estrogen plus progestin group (5 vs 11 deaths, HR = 0.42, 95% CI = 0.15 to 1.22).

conclusionIn postmenopausal women, continuous combined estrogen plus progestin decreases endometrial cancer incidence.

Indexed as

Estrogen Replacement TherapyAgedDouble-Blind MethodDrug Administration ScheduleEndometrial NeoplasmsEstrogens, Conjugated (USP)FemaleHumansHysterectomyIncidenceKaplan-Meier EstimateMedroxyprogesterone AcetateMiddle AgedOdds RatioPostmenopauseUnited StatesEstrogens, Conjugated (USP)Medroxyprogesterone Acetate

Identifiers

PMID26668177
PMCPMC5072373
OpenAlexW2210737500

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.