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Read Original Story

New study firmly ties hormone use to breast cancer

Rating

4 Star

New study firmly ties hormone use to breast cancer

Our Review Summary

The story does a good job presenting 2002 data from the Women’s Health Initiative (WHI) on the increased risk of developing breast cancer with prolonged use of HRT (also termed estrogen plus progestin treatment).  However, the story does not accurately report the results of the recent JAMA paper:

  • Even women who took estrogen and progestin pills for as little as a couple of years had a greater chance of getting [all types of] cancer."  There is nothing in this study to contradict the earlier WHI report showing that breast cancer risks start to diverge after about 4 years , not "a couple of years". This article reports on all cancers, not just breast.  Nowhere in the JAMA article are all cancers plotted over time to support the assertion of a couple of years.  Followed by the assertion that "…these new findings are likely to end any doubt that the risks outweigh the benefits," this creates the inaccurate impression that there are new data showing breast cancer risks start earlier on in the course of treatment.
  • A second inaccuracy concerns the statements about the size of the observed risk of breast cancer: "At the peak, the breast cancer risk for pill takers was twice that of the others."  Not accurate: the hazard ratio was 1.26, indicating a 26% higher breast cancer risk, not 100% higher (which would be twice the risk).
  • Finally, a main point of the article–that cancer risk [presumably all cancer, not just breast] returns to normal roughly 2 years after quitting — is not supported by the study results.  JAMA article states "The HR for overall risk of all malignancies increased from 1.03…to 1.24…in the postintervention period."  And, "…a downward inflection in the temporal trend in cumulative HRs for breast cancer was observed over time (not shown) but the observed change…is not statistically significant."

Despite the misplaced emphasis in the story compared with the source article, public health and cancer specialists put the results of the study in context and reassure women that their risk profile might be different if they are younger or older (women in the study were in their 60’s, typically after menopause is complete). 

The story lists HRT as one option for treating very bothersome menopausal symptoms; however, HRT should be used judiciously and only for a short time.   There are also other options for managing hot flashes and bothersome menopausal symptoms, which the story does not mention.  But for some women, low-dose HRT may still be the most appropriate treatment.  Women who are considering this choice need accurate information to weigh the risks and benefits of HRT, and the story appropriately provides absolute and relative risks of taking HRT for the short and long-term (5 1/2 years). The story gives number of cases of breast cancer per 1000 women for those who took hormone therapy v. non-users.

Lastly, the story does not address the cost of estrogen plus progestin treatment, nor the costs added or saved due to complications of or benefits from that therapy. However, the story advocates for selective use of low-dose HRT.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

 The story does not address the cost of estrogen plus progestin treatment, nor the costs added or saved due to complications of or benefits from that therapy. However, the story advocates for selective use of low-dose HRT, and only for use in the short-term if menopausal symptoms are bothersome and negatively affect quality of life.

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

Satisfactory

The story provides absolute and relative risks of taking HRT for the short and longer term. The story gives number of cases of breast cancer per 1000 women for those who took hormone therapy v. non-users. The story does an excellent job explaining the return to normal lifetime risk of breast cancer if a woman stops taking HRT.

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

Not Satisfactory

The story does not report the results of the JAMA study accurately. There is misplaced emphasis in the story compared with the study.  Statements which appear erroneous:

 "Even women who took estrogen and progestin pills for as little as a couple of years had a greater chance of getting [all types of] cancer."  There is nothing in this study to contradict the earlier WHI report showing that breast cancer risks start to diverge after about 4 years , not "a couple of years". This article reports on all cancers, not just breast.  Nowhere in the JAMA article are all cancers plotted over time to support the assertion of a couple of years.  Followed by the assertion that "…these new findings are likely to end any doubt that the risks outweigh the benefits," this creates the inaccurate impression that there are new data showing breast cancer risks start earlier on in the course of treatment.

A second inaccuracy concerns the statements about the size of the observed risk of breast cancer: "At the peak, the breast cancer risk for pill takers was twice that of the others."  Not accurate: the hazard ratio was 1.26, indicating a 26% higher breast cancer risk, not 100% higher (which would be twice the risk).

Finally, a main point of the article–that cancer risk [presumably all cancer, not just breast] returns to normal roughly 2 years after quitting — is not supported by the study results.  JAMA article states "The HR for overall risk of all malignancies increased from 1.03…to 1.24…in the postintervention period."  And, "…a downward inflection in the temporal trend in cumulative HRs for breast cancer was observed over time (not shown) but the observed change…is not statistically significant."

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

Satisfactory

The story does an excellent job presenting the latest information from the Women’s Health Initiative on the risk of breast cancer with prolonged use of HRT.  The story explains the study design and also interprets the results for the lay reader. Physician interviews put the results of the study in context and reassure women that their risk profile might be different if they are younger or older (women in the study were in their 60’s, typically after menopause is complete), and that their risk should return to normal a few years after stopping a short-term course of HRT.

Does the story commit disease-mongering?

Satisfactory

The story does not present menopause as a disease.  Based on information on the risks and benefits of HRT for women in their 50’s, the story reiterates the message from the preliminary WHI report, which is that women should make an informed decision with their physician on this treatment option to help manage severe menopausal symptoms.  The story reinforces the idea that menopausal symptoms do not require treatment.

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

Satisfactory

The story cites several excellent sources, including public health and cancer specialists, who put the results of previous Women’s Health Initiative and this latest information in context.   Wyeth Pharmaceuticals is cited on the benefit of HRT in the short-term, and their potential conflict as the maker of Prempro is noted.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story lists HRT as one option for treating very bothersome menopausal symptoms.  But other non-medication options are also available, as are non-hormonal drugs used "off-label" to ease menopausal symptoms. These are not mentioned.

 

 

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

Satisfactory

Hormone replacement therapy (HRT) is currently available for women who wish to alleviate particularly bothersome menopausal symptoms, such as hot flashes and vaginal dryness.  However, as the story notes, HRT should be used judiciously and only for a short time.  The story presents information from the Women’s Health Initiative (WHI) on the increased risk of breast cancer with HRT.  The subsequent decline in HRT use after WHI data was made public in 2002 has been linked to a decline in breast cancer cases.

Does the story establish the true novelty of the approach?

Satisfactory

HRT is not a new option for treating bothersome symptoms of menopause. It was originally thought that taking estrogen plus progestin treatment could help reduce a woman’s risk of developing age-related heart disease and bone loss.  Data from 2002 WHI showed that HRT increased the risk of health disease and breast cancer, and many women discontinued use of this treatment. 

WHI data discussed in this story reinforce the message that for many women, the risks of HRT outweigh the benefits.   There are also other options for managing hot flashes and bothersome menopausal symptoms, which the story does not mention. But for some women, low-dose HRT may still be the most appropriate short-term solution. 

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

Satisfactory

The story cites several sources and contains independent reporting. 

Total Score: 7 of 10 Satisfactory

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