commentary: re: Lengthened WHI Follow-Up: Postmenopausal Estrogen Therapy - Women's Health

full free access: Health Outcomes After Stopping Conjugated Equine Estrogens Among Postmenopausal Women With Prior Hysterectomy, April 6, 2011— JAMA

Risk assessment for recurrent venous thrombosis – The Lancet (as it applies to transdermal oestrogens)

Note:  author's response to commentaries on the original research article,  links  included to the discussion

PLOS Medicine: Promotional Tone in Reviews of Menopausal Hormone Therapy After the Women's Health Initiative: An Analysis of Published Articles

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Original Article Promotional Tone in Reviews of Menopausal Hormone Therapy After the Women's Health Initiative: An Analysis of Published Articles

0 responses	Promotional Tones - Hormone Therapy after WHI	Posted by sandipniauskas on 23 Mar 2011 at 08:32 GMT
Most recent response on 23 Mar 2011 at 08:32 GMT
2 responses	Pfizer Comment	Posted by cloder on 17 Mar 2011 at 17:54 GMT
Most recent response on 22 Mar 2011 at 20:50 GMT
1 response	Money isn't enough	Posted by lexchin on 16 Mar 2011 at 16:55 GMT
Most recent response on 17 Mar 2011 at 14:27 GMT
0 responses	Follow the money...	Posted by EthicalNag on 16 Mar 2011 at 14:40 GMT
Most recent response on 16 Mar 2011 at 14:40 GMT

Hormone Therapy: The Next Chapter - Harvard Health Publications

March 2011 Hormone therapy still has a place for treating menopause symptoms - Harvard Health Publications

Note: WHI (Women's Health Initiative)

"....But the WHI left many questions unanswered.....cont'd

Postmenopausal hormone use and incident ovarian cancer: Associations differ by regimen- Intl Journal of Cancer

"......Neither current nor former E + P use was associated with ovarian cancer risk (RR 1.08, 95% CI 0.86–1.35; RR 1.08, 95% CI 0.68–1.71, respectively, per 5-year increment). These findings suggest that progestins may mitigate some of the detrimental effects of estrogen on the ovarian epithelium."

CRD Summary/Commentary: Increased ovarian cancer risk associated with menopausal estrogen therapy is reduced by adding a progestin

original link source: http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=12009104538

Reference: Cancer 2009; 115(3): 531-539

Source: DARE

 

Date published: 15/02/2011 14:53

Summary

by: Hazel Burnham
 

CRD Summary: The authors concluded that oestrogen therapy use increased ovarian cancer in a duration-dependent manner; adding progestins appeared to reduce this effect to some extent. The conclusions appeared to be supported by the evidence but the limited search, lack of reporting of review methods and study quality, and reliance upon predominantly observational studies mean that findings should be interpreted with caution.
CRD Commentary: The review question was stated and appropriate inclusion criteria were defined. Limiting the search to English language published studies identified in one database plus references and linked articles may have resulted in the omission of other relevant studies and raised the potential for publication and language bias. However, no evidence of publication bias was found. Methods used to select studies and extract data were not described, so it is not known whether efforts were made to reduce reviewer errors and bias. Study validity was not assessed, so results from these studies and any synthesis may not be reliable.
Other than duration of oestrogen-only therapy/oestrogen plus progestin therapy use, no information was provided about participants. No information was provided about which potential confounders were adjusted for in individual studies. Data were pooled using meta-analysis and heterogeneity was assessed. Studies were predominantly observational and adjustments were made for potential confounders. The authors’ conclusions appeared to be supported by the evidence, but the limited search, lack of reporting of review methods and study quality, and reliance upon predominantly observational studies mean that findings should be interpreted with caution.

About this library entry

Category: 6.4.1 Female sex hormones | Cancer: gynaecological | Menopause / hormone replacement therapy (HRT)

NeLM area: Evidence > Medication Safety

DARE abstract

abstract only: Update in Hormone Therapy Use in Menopause -- Journal of Clinical Endocrinology & Metabolism

Hormone Therapy At Menopause May Pose Breast Cancer Risk — J. Natl. Cancer Inst.

abstract: Hormone replacement therapy and breast cancer

Hormone replacement therapy and breast cancer.

Howell A, Evans GD.

Genesis Prevention Centre, University Hospital of South Manchester, Manchester, M23 9LT, UK, anthony.howell@christie.nhs.uk.

Abstract

There is evidence that hormone replacement therapy (HRT) may both stimulate and inhibit breast cancers, giving rise to a spectrum of activities, which are frequently hard to understand. Here we summarise the evidence for these paradoxical effects and, given the current data, attempt to give an indication where it may or may not be appropriate to prescribe HRT.It is clear that administration of oestrogen-progestin (E-P) and oestrogen alone (E) HRT is sufficient to stimulate the growth of overt breast tumours in women since withdrawal of HRT results in reduction of proliferation of primary tumours and withdrawal responses in metastatic tumours. E-P, E including tibolone are associated with increased local and distant relapse when given after surgery for breast cancer. For women given HRT who do not have breast cancer the only large randomised trial (WHI) of E-P or E versus placebo has produced some expected and also paradoxical results. E-P increases breast cancer risk as previously shown in observational studies. Risk is increased, particularly in women known to be compliant. Conversely, E either has no effect or reduces breast cancer risk consistent with some but not all observational studies. Two observational studies report a decrease or at least no increase in risk when E-P or E are given after oophorectomy in young women with BRCA1/2 mutations. Early oophorectomy increases death rates from cardiovascular and other conditions and there is evidence that this may be reversed by the use of E post-oophorectomy. HRT may thus reduce the risk of breast cancer and other diseases (e.g., cardiovascular) in young women and increase or decrease them in older women.

video: SABCS 2010: Dr. Joseph Ragaz MD, what will be the impact on future trials from the data pulled from Women's Health Initiative about Estrogen-Only Hormone Therapy?

Margaret Polaneczky, MD - HRT Worries – This Time, It’s Ovarian Cancer Again…. | The Blog That Ate Manhattan (see simple charts)

New Strategies in Ovarian Cancer: Uptake and experience of women at high risk of ovarian cancer who are considering risk-reducing salpingo-oophorectomy

Abstract

This paper reviews factors associated with uptake of risk-reducing salpingo-oophorectomy by women at increased hereditary risk for ovarian cancer, as well as quality of life issues following surgery. Forty one research studies identified through PubMed and PsychInfo met inclusion criteria. Older age, having had children, a family history of ovarian cancer, a personal history of breast cancer, prophylactic mastectomy, and BRCA1/2 mutation carrier status increase the likelihood of undergoing surgery. Psychosocial variables predictive of surgery uptake include greater perceived risk of ovarian cancer and cancer-related anxiety. Most women report satisfaction with their decision to undergo surgery and both lower perceived ovarian cancer risk and less cancer-related anxiety as benefits. Hormonal deprivation is the main disadvantage reported, particularly by premenopausal women who are not on hormonal replacement therapy (HRT). The evidence is mixed regarding satisfaction with the level of information provided prior to surgery, although generally women report receiving insufficient information regarding the pros and cons of HRT. These findings indicate that when designing decision aids, demographic, medical history, and psychosocial variables need to be addressed in order to facilitate quality decision making.

Wyeth paid writers to promote hormone therapy: study | Reuters

Longer HRT Duration Tied to Lower Colon Cancer Risk

"It is possible that widespread use of HRT is partially responsible for the reductions that we have observed in distal large bowel cancer incidence over time," the authors write.

As I see it: Ten reasons to be happy about hormone replacement therapy: a guide for patients - Menopause International

"Discussion of side-effects should not be avoided, particularly the 1% extra lifetime risk of breast cancer. This should be balanced against the fewer heart attacks, fewer deaths and less osteoporotic fractures in those who start HRT below the age of 60."

Editorial: Note from the editors: change is afoot -- Menopause International

Note: in the absence of available full paper/s (pay per view/subscription) of the several related articles blogged, there is no reference to those with genetic predispositions/risks/advantages with hormone replacement therapy. The one abstract (Review - Hinds/Price) discusses risks related to sarcoma/granulosa but no mention of genetics eg. BRCA's/familial colorectal cancers and/or prior research regarding ERT/colorectal cancers.

"Our understanding of the menopause and the management of its issues is in a continual state of flux. Since the publication of the original Women's Health Initiative study and the immediate conclusions and position statements from various specialist societies and regulatory authorities, clinicians have had little choice other than to significantly change their clinical management. So, is this a change for good? Whether you were a supporter or detractor of hormone replacement therapy (HRT), or even sat on the academic fence you will be aware that many clinicians have withdrawn from even discussing the place of HRT in the management of menopausal issues with their patients. This cannot be a good thing...."cont'd

Compliance with estrogen hormone replacement therapy after oophorectomy: a prospective study -- Menopause International

Results. The median age of women at the time of hysterectomy was 42 (range 22–46) years

Menopause, hormone replacement and gynaecological cancers -- Menopause International

Note: abstract, full access via subscription ($$$)

Reviews

Menopause, hormone replacement and gynaecological cancers

Lynsey Hinds and John Price
Belfast City Hospital, Northern Ireland
Correspondence: Dr Lynsey Hinds, 1 Strawhill Manor, Donaghcloney, Belfast BT66 7GH Northern Ireland. Email: hindslynsey@hotmail.co.uk
 
Approximately 18,000 women are diagnosed with a gynaecological cancer in the UK each year. Predisposing risk factors for some of these gynaecological cancers include an early menarche/late menopause and hormone replacement therapy (HRT). Furthermore, treatment of gynaecological malignancies often induces an iatrogenic menopause, which may be more severe than a natural onset. HRT is an extremely effective treatment that may dramatically improve physical and psychological symptoms and ultimately quality of life in patients with cancer. However, the safety of using HRT in patients with gynaecological cancer is a controversial issue and not entirely clear. The main concern is the theoretical risk of the stimulation of residual cancer cells by estrogen replacement. The review of the evidence in this article found that for most gynaecological cancers this hypothesis was not proven. No study to date has found HRT to have a detrimental effect on survival in patients with early stage endometrial cancer, epithelial ovarian cancer, cervical cancer and vulval tumours. HRT is only an absolute contraindication in low-grade endometrial stromal sarcomas and is best avoided in granulosa cell ovarian tumours. Therefore, HRT should not be withheld in the majority of patients with gynaecological cancer. If quality of life is being adversely affected by symptoms of the menopause, then patients with cancer should be counselled regarding the known risks and benefits of HRT to enable them to make an informed decision on their treatment.