Hormone replacement therapy: the need to combine clinical and epidemiological data
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2012
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Olver, I.N.
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Journal article
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Cancer Forum, 2012; 36(3):171-174
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Abstract
In decision-making about the use of hormone replacement therapy, the risk/benefit analysis should encompass both clinical and epidemiological risk/benefit information. Many women benefit from the use of hormone replacement therapy to control the symptoms of menopause. However, there is evidence from observational studies and randomised trials of a temporal relationship between some hormone replacement therapy use and the risk of breast cancer. Both the Million Women Study and the Women’s Health Initiative showed an increase in the risk of breast cancer, particularly with combined oestrogen and progestagen hormone replacement therapy, which increased with duration of use and was greater if the hormone replacement therapy commenced closer to menopause. They differ in the magnitude of risk and whether there is any increased risk of breast cancer with oestrogen-only hormone replacement therapy. The Million Women Study showed increased risks of endometrial and ovarian cancer with the use of unopposed oestrogens, while the Women’s Health Initiative demonstrated an increased risk of lung cancer with combination hormone replacement therapy. Epidemiological studies show that the incidence of breast cancer falls in women over 50 years and older as hormone replacement therapy use reduces. The clinical translation of these results is that for women who require treatment for symptoms of menopause, the short-term use of unopposed oestreogens would be associated with the least risk of breast cancer (but non-hysterectomised women would have an increased risk of endometrial cancer).
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Copyright 2012 Ian Olver