Speciality
Spotlight

 




 


Oncology


 

 





Hormone
Replacement Therapy

         

  • K
    Nanda, et al (Duke Univ, Durham, NC) 
    Hormone-Replacement
    Therapy and the Risk of Colorectal Cancer: A
    Meta-analysis.

    Obstet Gynecol 93: 880-888, 1999

        

    Conclusion
    – Among recent postmenopausal HRT users, the risk of
    colon cancer may be decreased. 
    In HRT users, the risk of fatal colon cancer may
    also be lower, although data are limited.

        

    This
    meta-analysis of studies performed to determine the
    relation of use of HRT to colon cancer found that use of
    HRT was associated with a significant reduction in risk
    of developing colon cancer. 
    A similar reduction was noticed in the large
    Nurses’ Health Study. The
    risk of developing rectal cancer with HRT was reduced in
    the Nurses’ Health Study, but not in this meta-analysis.
    In both the Nurses’ Health Study and the
    meta-analysis, the protective effect of HRT was limited
    to current or recent use.
    Postmenopausal women who are deciding whether or
    not to use HRT should be informed about these data.

           

  • Hormone Replacement Therapy and
    the Risk of Epithelial Ovarian Carcinoma: A
    Meta-analysis.

    PP
    Garg, et al (Johns Hopkins Univ, Baltimore, Md; Univ of
    California, San Francisco) 
    Obstet Gynecol  
    92:474-479, 1998.

          

    A search
    through Medline of studies published in a 30 year period
    was conducted to examine the association of HRT and
    ovarian cancer.

         

    Conclusion
    – An increased risk of developing epithelial carcinoma
    of the ovary may be associated with prolonged use of
    hormone therapy by postmenopausal women, particularly
    longer than 10 years. 
    However, there is still not enough epidemiologic
    evidence to infer causality.

          

    This
    meta-analysis of published observational studies shows a
    small increased risk of developing epithelial ovarian
    carcinoma associated with postmenopausal HRT. However, as the authors conclude, there is not
    enough epidemiologic evidence to infer that a causal
    relation exists between HRT and invasive ovarian
    carcinoma. Certain
    criteria described by Bradford Hill need to be present
    to conclude that causality exists between 
    an intervention and an event in observational
    studies such as those analyzed in this study. One of these criteria is strength of association,
    which was very weak in this analysis with an odd ratio
    of 1.15. The
    increased risk of 1.27 with more than 10 years of
    hormone use was of borderline statistical significance
    as the confidence intervals reached 1. Another criterion is consistency in the studies
    As Table 1 shows the findings of the various studies are
    inconsistent. Some
    report no risk, and others report a slightly increased
    risk of ovarian cancer with use of hormone replacement
    therapy. Therefore,
    these do not appear to have sufficient strength to
    affect the decision of a woman regarding the use of
    hormone replacement therapy.

        

  • Putting
    the Risk of Breast Cancer in Perspective.

    K-A
    Pillips, et al (Princess Margaret Hosp, Toronto; Ontario
    Cancer Genetics Networks, Canada; Cancer Care Ontario,
    Toronto)

    N Engl J Med  340: 141-144,
    1999.

         


    Background
    – Women tend to overestimate their risk of breast
    cancer. This
    occurs in part because the “1 in 9” statistic
    often quoted in the media is based on the cumulative
    lifetime risk for a women aged 85 years or older, yet
    breast cancer is uncommon at younger ages.

       

    Method
    :The 1995 Ontario Cancer Registry was examined to
    determine, based on a cohort of 1000 women, the number
    who died of breast cancer, lung cancer, or
    cardiovascular causes (including cerebrovascular
    events).

       

    Findings:
    The greatest proportion of deaths caused by breast
    cancer occurs in middle-aged women, in whom 20% of all
    deaths are caused by breast cancer. However, at other ages, the proportion of deaths
    resulting from cardiovascular disease is greater than
    that caused by breast cancer, particularly for women
    aged 60 years or older. The proportion of deaths resulting from lung
    cancer is similar to that caused by breast cancer, with
    breast cancer deaths peaking in middle age and lung
    cancer deaths peaking between 50 and 69 years of age.

       

    Conclusion
    drawn from this study as well as other studies have
    shown that more women primarily fear cancer (61%) rather
    than cardiovascular disease (9%), when actually
    cardiovascular disease is the greatest killer. Better education about the risk of breast cancer
    is needed, so that patients will not forego important
    therapies (such as estrogen replacement therapy) for the
    fear of developing breast cancer.

          


 

 



 

 

Speciality Spotlight

 

 

Hormone Replacement Therapy
         

  • K Nanda, et al (Duke Univ, Durham, NC)  Hormone-Replacement Therapy and the Risk of Colorectal Cancer: A Meta-analysis.
    Obstet Gynecol 93: 880-888, 1999
        
    Conclusion – Among recent postmenopausal HRT users, the risk of colon cancer may be decreased.  In HRT users, the risk of fatal colon cancer may also be lower, although data are limited.
        
    This meta-analysis of studies performed to determine the relation of use of HRT to colon cancer found that use of HRT was associated with a significant reduction in risk of developing colon cancer.  A similar reduction was noticed in the large Nurses’ Health Study. The risk of developing rectal cancer with HRT was reduced in the Nurses’ Health Study, but not in this meta-analysis. In both the Nurses’ Health Study and the meta-analysis, the protective effect of HRT was limited to current or recent use. Postmenopausal women who are deciding whether or not to use HRT should be informed about these data.
           

  • Hormone Replacement Therapy and the Risk of Epithelial Ovarian Carcinoma: A Meta-analysis.
    PP Garg, et al (Johns Hopkins Univ, Baltimore, Md; Univ of California, San Francisco)  Obstet Gynecol   92:474-479, 1998.
          
    A search through Medline of studies published in a 30 year period was conducted to examine the association of HRT and ovarian cancer.
         
    Conclusion – An increased risk of developing epithelial carcinoma of the ovary may be associated with prolonged use of hormone therapy by postmenopausal women, particularly longer than 10 years.  However, there is still not enough epidemiologic evidence to infer causality.
          
    This meta-analysis of published observational studies shows a small increased risk of developing epithelial ovarian carcinoma associated with postmenopausal HRT. However, as the authors conclude, there is not enough epidemiologic evidence to infer that a causal relation exists between HRT and invasive ovarian carcinoma. Certain criteria described by Bradford Hill need to be present to conclude that causality exists between  an intervention and an event in observational studies such as those analyzed in this study. One of these criteria is strength of association, which was very weak in this analysis with an odd ratio of 1.15. The increased risk of 1.27 with more than 10 years of hormone use was of borderline statistical significance as the confidence intervals reached 1. Another criterion is consistency in the studies As Table 1 shows the findings of the various studies are inconsistent. Some report no risk, and others report a slightly increased risk of ovarian cancer with use of hormone replacement therapy. Therefore, these do not appear to have sufficient strength to affect the decision of a woman regarding the use of hormone replacement therapy.
        

  • Putting the Risk of Breast Cancer in Perspective.
    K-A Pillips, et al (Princess Margaret Hosp, Toronto; Ontario Cancer Genetics Networks, Canada; Cancer Care Ontario, Toronto)
    N Engl J Med  340: 141-144, 1999.
         
    Background – Women tend to overestimate their risk of breast cancer. This occurs in part because the “1 in 9” statistic often quoted in the media is based on the cumulative lifetime risk for a women aged 85 years or older, yet breast cancer is uncommon at younger ages.
       
    Method :The 1995 Ontario Cancer Registry was examined to determine, based on a cohort of 1000 women, the number who died of breast cancer, lung cancer, or cardiovascular causes (including cerebrovascular events).
       
    Findings: The greatest proportion of deaths caused by breast cancer occurs in middle-aged women, in whom 20% of all deaths are caused by breast cancer. However, at other ages, the proportion of deaths resulting from cardiovascular disease is greater than that caused by breast cancer, particularly for women aged 60 years or older. The proportion of deaths resulting from lung cancer is similar to that caused by breast cancer, with breast cancer deaths peaking in middle age and lung cancer deaths peaking between 50 and 69 years of age.
       
    Conclusion drawn from this study as well as other studies have shown that more women primarily fear cancer (61%) rather than cardiovascular disease (9%), when actually cardiovascular disease is the greatest killer. Better education about the risk of breast cancer is needed, so that patients will not forego important therapies (such as estrogen replacement therapy) for the fear of developing breast cancer.
          

 

 

 

By |2022-07-20T16:44:14+00:00July 20, 2022|Uncategorized|Comments Off on Hormone Replacement Therapy

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