This news release lists several non-pharmalogical steps for relieving menopausal symptoms of women who have been treated for breast cancer. The main takeaway is that most women who have been treated for breast cancer shouldn’t receive hormone therapy, but instead focus on lifestyle changes although some emerging pharmacologic approaches were listed as well.
It’s not clear from either the news release or the published study how researchers drew their conclusions. The release states that clinical trials, observational studies, guidelines, and expert opinion were analyzed, but no study data is provided to put the findings in perspective.
Women who are dealing with premature menopause as a result of breast cancer treatment would benefit from a better understanding of risks and benefits of treatments.
The news release states that there are 9.3 million breast cancer survivors worldwide but doesn’t note, as the study does, that 43 percent of these are older than 65 at diagnosis and thus would not have menopausal symptoms due to chemotherapy for their breast cancer. The study also notes that 25 percent of those diagnosed are below age 50 and are thus more likely to be pre-menopausal at diagnosis. By not including those breakdowns the news release makes chemotherapy-induced menopause seem more prevalent than it is.
The report lists a variety of methods for reducing menopausal symptoms, but no costs associated with any of the methods are mentioned.
Many of the recommended methods — like cognitive behavioral therapy, hypnosis and acupuncture — may not be covered by insurance or even available to many women depending on their location.
No numerical context is given in the news release showing how lifestyle modifications might benefit breast cancer survivors with menopausal symptoms. For example, did any of the studies find an association between smoking cessation and reduced hot flashes or nighttime sweating?
A breast cancer diagnosis may be incentive for women to make healthy lifestyle changes. Knowing the benefits of each of the lifestyle modifications mentioned would help women decide which change they would like to make.
No harms were mentioned in the release. The only nod to harms was the recommendation that women who were treated with chemotherapy for breast cancer should not be treated with hormone therapy.
The news release mentions that the results were based on a comprehensive review of “controlled clinical trials, observational studies, evidence-based guidelines, and expert opinion from professional societies.” Unfortunately, in neither the release or the original article is there a description of the criteria used to determine which articles were used in the review. Before the quality of evidence can be assessed we need to know some basics: How many women were included in the studies? How long were the studies? What were some limitations?
The review did not commit disease mongering. However, by omitting the breakdown of breast cancer survivors by age the release might give the impression that chemotherapy-induced menopause symptoms are higher than they actually are. As noted above, the study states that 43 percent of these women are older than 65 at diagnosis and would not have chemotherapy induced menopausal symptoms.
The release doesn’t state any funding sources. Several of the review authors have received industry funding and any relevant industry funding should be noted in the release.
The release lists things women should do to help relieve menopausal symptoms, but there are no comparisons of which ones may be more beneficial. Knowing which ones offered the strongest benefits would help women decide on which approaches to follow. It’s unrealistic to suggest that all women would be willing or able to make all of the modifications recommended. We’ve all heard these messages throughout our lives. A cancer diagnosis may be the incentive needed to make changes but women deserve to know which changes have the potential for the greatest benefit.
Although lifestyle changes are readily available, it’s unclear if the emerging approaches (“selective estrogen receptor modulators (SERMs), Tissue selective estrogen complex (TSECs), estetrol, and neurokinin B inhibitors”) listed in the release are even available. Some of the recommended lifestyle changes aren’t available to women with limited access to healthy foods which are often more costly even if they are available. Lack of insurance coverage and lack of availability of alternative treatments like cognitive behavior therapy, acupuncture and hypnosis put these modifications out of reach for many women.
Besides listing lifestyle approaches which are not novel, it’s unclear if the emerging approaches listed are novel.
The release did not use unjustifiable language.