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Read Original Story

Hormone therapy redeemed

Rating

4 Star

Hormone therapy redeemed

Our Review Summary

In 2002, the results of the Women's Health Initiative (WHI) dramatically changed the way menopausal hormone replacement therapy (HRT) was prescribed in the U.S. A recent study re-evaluates that same data and finds that when the HRT is started relative to menopause may influence whether the risk of heart disease and stroke is indeed elevated. The investigators found that women who were very close to menopause had no increased risk of heart disease, but that women who were further out from menopause did have an elevated risk. Although these results were not statistically significant, they do appear to support the current recommendations that HRT be used to treat menopausal symtoms for short periods of time and should not be used for longer periods of time in the hope of preventing heart disease.

This story adequately describes the strength of the available evidence by pointing out that this study was a re-analysis of the existing data and did not represent a new study.

However, the story fails to quote independent researchers who were not affiliated with the study. Because the consensus on the clinical utility of HRT has changed substantially in the past decade, it would have been useful to have other clinicians provide some perspective on how this new information may or may not change current practice.

The story describes the potential harms of HRT. However it does not adequately quantify the harms of HRT. Although the story provides quantification of the harms in relative terms (by providing the percentage of increased risk of stroke and breast cancer), this is not enough. Because the incidence of stroke and breast cancer was very low in this population (particularly in the younger women), only presenting the risks in terms of relative risk tends to exaggerate the true risk to the patient. In this situation, presenting the harms in terms of absolute risk would be much more helpful to a patient trying to make an informed decision about whether to take hormone therapy. For example, the lifetime risk of breast cancer for a 50 year old woman is 13%. An increase of 19% in risk as cited in the article translates to a lifetime risk of about 15%. In this situation, a woman can decide if the relief of her menopausal symptoms is worth increasing her lifetime risk of breast cancer from 13% to 15%. (See our primer on absolute vs. relative risk.)

Criteria

Does the story adequately discuss the costs of the intervention?

Not Applicable

The story does not mention costs. However in this context, where the cost of treatment is relatively low, this criterion seems less relevant.

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

Not Satisfactory

The story only provides quantification of the harms of hormone therapy in relative terms. Because the incidence of stroke and breast cancer was very low in this population (particularly in the younger women), only presenting the risks in terms of relative risk tends to exaggerate the true risk to the patient. In this situation, presenting the harms in terms of absolute risk would be much more helpful to a patient trying to make a decision about whether to take hormone therapy. For example, the lifetime risk of breast cancer for a 50 year old woman is 13%. An increase of 19% in risk as cited in the article translates to a lifetime risk of about 15%. In this situation, a woman can decide if the tradeoff of increasing her risk of breast cancer from 13% to 15% is worth the relief from her menopausal symptoms.

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

Satisfactory

The story adequately describes the harms of hormone therapy, which include a higher risk of heart disease, stroke and breast cancer (but see "quantification of benefit" criterion below).

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

Satisfactory

The story adequately describes the design of the current study. The story clearly states that this study was a re-analysis of the existing data and did not represent a new study.

Does the story commit disease-mongering?

Satisfactory

The story does not appear to engage in disease mongering.

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

Not Satisfactory

The story quotes two clinicians, both of whom are authors on the current study. The story should have quoted other clinicians who are not affiliated with the study who could have provided some perspective.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story does not mention the various supplements, such as black cohosh, that are used to treat menopausal symptoms.

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

Satisfactory

The story clearly states that hormone therapy has been around for a long time and is very common.

Does the story establish the true novelty of the approach?

Satisfactory

Hormone therapy is clearly not a new idea.

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

Not Applicable

There is no way to know if the story relied on a press release as the sole source of information.

Total Score: 5 of 8 Satisfactory

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