Open Access

Yu Tian, Yi Lin, Conghui Qu, Volker Arndt, James W. Baurley, Sonja I. Berndt, Stephanie A. Bien, D. Timothy Bishop, Hermann Brenner, Daniel D. Buchanan, Arif Budiarto, Peter T. Campbell, Robert Carreras-Torres, Graham Casey, Andrew T. Chan, Rui Chen, Xuechen Chen, David V. Conti, Virginia Díez-Obrero, Niki Dimou, David A. Drew, Jane C. Figueiredo, Steven Gallinger, Graham G. Giles, Stephen B. Gruber, Marc J. Gunter, Sophia Harlid, Tabitha A. Harrison, Akihisa Hidaka, Michael Hoffmeister, Jeroen R. Huyghe, Mark A. Jenkins, Kristina M. Jordahl, Amit D. Joshi, Temitope O. Keku, Eric Kawaguchi, Andre E. Kim, Anshul Kundaje, Susanna C. Larsson, Loic Le Marchand, Juan Pablo Lewinger, Li Li, Victor Moreno, John Morrison, Neil Murphy, Hongmei Nan, Rami Nassir, Polly A. Newcomb, Mireia Obón-Santacana, Shuji Ogino, Jennifer Ose, Bens Pardamean, Andrew J. Pellatt, Anita R. Peoples, Elizabeth A. Platz, John D. Potter, Ross L. Prentice, Gad Rennert, Edward A. Ruiz-Narvaez, Lori C. Sakoda, Robert E. Schoen, Anna Shcherbina, Mariana C. Stern, Yu-Ru Su, Stephen N. Thibodeau, Duncan C. Thomas, Konstantinos K. Tsilidis, Fränzel J. B. van Duijnhoven, Bethany van Guelpen, Kala Visvanathan, Emily White, Alicja Wolk, Michael O. Woods, Anna H. Wu, Ulrike Peters, W. James Gauderman, Li Hsu, Jenny Chang-Claude

• Background: Menopausal hormone therapy (MHT), a common treatment to relieve symptoms of menopause, is associated with a lower risk of colorectal cancer (CRC). To inform CRC risk prediction and MHT risk-benefit assessment, we aimed to evaluate the joint association of a polygenic risk score (PRS) for CRC and MHT on CRC risk. Methods: We used data from 28,486 postmenopausal women (11,519 cases and 16,967 controls) of European descent. A PRS based on 141 CRC-associated genetic variants was modeled as a categorical variable in quartiles. Multiplicative interaction between PRS and MHT use was evaluated using logistic regression. Additive interaction was measured using the relative excess risk due to interaction (RERI). 30-year cumulative risks of CRC for 50-year-old women according to MHT use and PRS were calculated. Results: The reduction in odds ratios by MHT use was larger in women within the highest quartile of PRS compared to that in women within the lowest quartile of PRS (p-value = 2.7 × 10−8). At the highest quartile of PRS, the 30-year CRC risk was statistically significantly lower for women taking any MHT than for women not taking any MHT, 3.7% (3.3%–4.0%) vs 6.1% (5.7%–6.5%) (difference 2.4%, P-value = 1.83 × 10−14); these differences were also statistically significant but smaller in magnitude in the lowest PRS quartile, 1.6% (1.4%–1.8%) vs 2.2% (1.9%–2.4%) (difference 0.6%, P-value = 1.01 × 10−3), indicating 4 times greater reduction in absolute risk associated with any MHT use in the highest compared to the lowest quartile of genetic CRC risk. Conclusions: MHT use has a greater impact on the reduction of CRC risk for women at higher genetic risk. These findings have implications for the development of risk prediction models for CRC and potentially for the consideration of genetic information in the risk-benefit assessment of MHT use.