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Abstract
From
2002 to 2003, the breast cancer incidence in the United States, as
reported by the National Cancer Institute's Surveillance Epidemiology
and End Results (SEER 9) database, appeared to decrease by 6.7%. This
phenomenon has been attributed to a reduction in the use of menopausal
hormone therapies after the initial publication of the Women's Health
Initiative (WHI) study results in July of 2002.
However, attempts to
draw a causal association between the use of menopausal hormone
therapies and the incidence of breast cancer have not accounted for the
facts that prescriptions of estrogen-plus-progestin menopausal
therapies, which are associated with increased rates of breast cancer,
fell by 53% from 2002 to 2003, while prescriptions of estrogen-only
therapies fell by only 27%. To address this issue,...
To address this issue, we analyzed the
effects of the higher rate of discontinuation of estrogen-plus-progestin
menopausal therapies relative to estrogen-only treatments during the
2002–2003 time period, based upon the effects of different types of
menopausal hormone therapies on breast cancer incidence as determined by
the WHI interventional hormone trials.
This approach demonstrates that
the relative persistence with menopausal estrogen-only therapies – as
compared to estrogen-plus-progestin therapies – can explain the
reduction in breast cancer incidence from 2002 to 2003. In addition, we
point out the incompatibility of the breast cancer incidence rates found
in the two WHI interventional hormone trials and the rates reported in
the SEER 9 database. Based on these findings, we conclude – as
previously demonstrated in the estrogen-only arm of the WHI
interventional hormone trials – that menopausal estrogen-only use is not
responsible for increasing the risk of breast cancer in menopausal
women and may, in fact, be protective. Additional studies are still
needed to better define the relationship between different types of
menopausal hormone therapies and the incidence of breast cancer.
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