[gdpawel]

A new study links the Prempro hormone replacement treatment, which is already linked to a higher risk of breast cancer and heart disease, to a higher risk of death. The data was published in the Journal of the American Medical Association. The study followed 12,788 women since 2002, when the federally funded Women's Health Initiative study that compared HRT with placebos was halted, after it became apparent that taking hormones elevated post-menopausal women's risk of breast cancer and heart attacks. Many experts say the gradual decline in the breast cancer incidence rate in the U.S. in the succeeding years can be directly traced to the decline in use.

In the findings, there were 678 cases of invasive breast cancer, including 385 for women taking hromones and 293 with a placebo. More women who took hormones died from breast cancer (0.03% versus 0.01% per year in the placebo). That amounts to 2.6 deatrhs per 10,000 women per years versus 1.3 deaths in the placebo group. The breast cancer among those who took hormones was also more likely to be invasive.

After the Women's Health Initiative was released in 2002, HRT use plummeted and led to a drop in breast cancer rates, with about 100,000 fewer invasive tumors detected from 2002 to 2007 than expected, said lead researcher Rowan Chlebowski, chief of medical oncology at the University of California, Los Angeles, School of Medicine, told Bloomberg News. Using a 10-year mortality rate of about 20 percent, he calculates the reduction in hormone use may have prevented about 20,000 deaths.

The findings should cause doctors to cut back on long-term usage to treat hot flashes and night sweats. “I don’t think you can say that now,” Chlebowski tells the news service. “I know some people have to take it because they can’t function, but the message now is that you really should try to stop after a year or two. Women should think critically about if they need this, if their symptoms are significant and if they would persist.”

In an accompanying editorial in JAMA, Peter Bach, a physician at Memorial Sloan-Kettering Cancer Center, writes that, “given the substantial population of women who seek relief from menopausal symptoms and the large potential burden of disease that could be created if medications given to alleviate symptoms today cause cancer and other deaths tomorrow, it seems that additional randomized trials are needed specifically to determine whether lower doses or shorter durations of hormone therapy could alleviate menopausal symptoms without increasing cancer risk.”

Bach noted that the difference in mortality rates between the two groups was continuing to widen seven years after stopping the drugs, and highlighted the fact the prognosis for those women who developed cancer was worse if they had taken hormones.

He also questioned the common strategy among physicians of prescribing hormones for women during the early years of menopause with the idea of stopping them later to avoid negative health consequences. Many women want the pills to relieve symptoms like decreased libido, vaginal dryness and painful intercourse, which can be destructive of family life in the early years of "the change."

Pharmalot