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Hormone therapy raises risk quickly, study finds

Rating

3 Star

Hormone therapy raises risk quickly, study finds

Our Review Summary

The focus of this story is a report of new data showing a statistically significant association between lobular breast cancer and short-term HRT (3 years or less).  The story creates an exaggerated sense of risk because there is no mention of absolute risk.  For breast cancer, estimated excess risk is 8 women/10,000 women per year developing breast cancer after 4 years of combined HRT use as compared with no hormone use.  

A current treatment approach for bothersome menopausal symptoms is a course of low-dose HRT for 3-5 years with frequent monitoring.  This course of treatment is considered safe for most women not already at high risk of developing breast cancer.  The clinician interviewed stresses frequent monitoring and an individualized approach to managing symptoms. 

The story notes various combinations of hormone replacement therapy (HRT)  available for reducing menopaual symptoms, such as hot flashes and vaginal dryness.  However, there is no discussion that menopause is a natural part of aging and unless symptoms are very bothersome, many women do not need to take HRT to ease symptoms common in menopause such as hot flashes, night sweats and vaginal dryness and discomfort.

The story does strike a balance by interviewing the lead author of the study and a gynecologist who put the new information in clinical perspective.  It would be helpful to hear from researchers of the Women’s Health Initiative for comment on how their data on breast cancer risk compared to the present study.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Applicable

The story does not specifically address cost of treatment.  However, since the focus is on causation of disease, the cost issue does not seem important here.

 

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The interview with a clinician puts the benefit of taking HRT in perspective; however, we are given no quantitative data to compare the risk of devleoping lobular cancer against the benefit of reduced menopausal symtoms via HRT.  The clinician interviewed stresses frequent monitoring and an individualized approach to managing symptoms. 

 

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The focus of this story is a report of new data showing a statistically significant association between lobular breast cancer and short-term HRT. Yet there is no mention of absolute risk.  For breast cancer estimated excess risk is 8 women/10,000 women per year developing breast cancer after 4 years of combined HRT use as compared with no hormone use.

 

  

Does the story seem to grasp the quality of the evidence?

Satisfactory

The story describes the  design of this case-control study and discusses the connection between increased risk of developing lobular cancer and shorter-duration HRT . However, the story could have mentioned that the case-control design of the study carries some inherent limitations in establishing causality vs association (e.g. recall bias).

Does the story commit disease-mongering?

Not Satisfactory

The story leaves the reader with an impression of an exaggerated sense of risk with short-term HRT, because it gives relative, not absolute risk data.   Also, lobular carcinoma is detected in the same way as ductal carcinoma – either because of a palpable lump detected on exam by woman or physician, or on a screening mammogram.

 

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story interviews the lead author of the study, as well as a gynecologist who puts the study in clinical perspective. The latter interview gives balance to the report.  It would be nice to hear from researchers of the Women’s Health Initiative, or other clinicians who could discuss treatment options for women considering HRT.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story does not discuss other treatment options for managing menopausal symptoms. There is no discussion here that menopause is a natural part of aging and not a condition which necessitates medical intervention. Unless symptoms are very bothersome, many women do not need to take HRT to ease symptoms common in menopause such as hot flashes, night sweats and vaginal dryness and discomfort.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story notes various combinations of hormone replacement therapy (HRT) available for  reducing menopaual symptoms, such as hot flashes and vaginal dryness.  The story notes that data from the Women’s Health Initiative on the risks of HRT have been available since 2002. (These risks include a slight increase risk of breast cancer for some women who take a longer course of HRT (> 4 years) and an increased risk of heart disease in older women.

Does the story establish the true novelty of the approach?

Satisfactory

Satisfactory because the story indicates that the treatment itself is not novel.

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story does not appear to rely solely or largely on a news release

Total Score: 5 of 9 Satisfactory

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