Healthy Skepticism Library item: 301

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Publication type: news

Woodman R.
British charities call for HRT review
2004 Apr 15

Full text:

British charities on Thursday called for restrictions on the use of hormone replacement therapies to be lifted following new findings that show oestrogen-alone formulations do not increase the risk of breast cancer.

The U.S. Women’s Health Initiative study of nearly 11,000 women between 50 and 79 years old with prior hysterectomy, found no significant difference in breast cancer and heart disease rates between subjects who received oestrogen and those who received placebo. However, 39% more strokes occurred in the oestrogen group, while fractures due to osteoporosis were reduced by 30%.

The findings contrast sharply with those of the Million Women Study, which identified a 30% increased risk in breast cancer with unopposed oestrogen use, prompting regulators to advise in December that HRT should no longer be used for to prevent osteoporosis and should be given only for the shortest possible time for the relief of vasomotor symptoms.

Women’s Health Concern and the British Menopause Society said in a joint statement they hope that British regulatory authorities will review the latest findings.

“Taking all these new findings into consideration, the balance of benefit to harm is greatly shifted favourably for HRT, when given for the correct reasons,” according to the statement. “Menopause experts recommend that clinicians should therefore continue to prescribe HRT for relief of menopausal symptoms, and for the prevention and treatment of postmenopausal osteoporosis, for as long as necessary and women should feel confident about using HRT.

“These outcomes are certainly not grounds for women to discontinue HRT, or for discouraging those who need it from starting,” the statement said.

The charities noted that the Million Women Study was an observational survey of women attending breast-screening clinics and might therefore be prone to bias whereas placebo-controlled randomised studies such as the WHI Study provide more reliable estimates of breast cancer risk.

“If the oestrogen-only arm of WHI has proven that the results of the Million Women Study were overestimated, then we also need to question the results of the combined HRT findings,” said Dr. John Stevenson, Chairman of Women’s Health Concern and a member of the British Menopause Society Council.

“Menopause experts have always accepted that there are increased risks with taking HRT long-term. In the short-term, however, the risk-benefit ratio sways in favour of HRT.”

Dr. Stevenson added: “When the Million Women Study was first publicised many doctors questioned the validity of the study. Yet the regulatory authorities did not seem to consider this, preferring to listen to epidemiologists rather than the medical experts who actually treat menopausal women and have been involved in years of clinical research on this very topic.”

The charities agreed that the WHI finding on heart disease is disappointing but not unexpected given the dosage of HRT. They added that UK women using HRT are generally much younger than those in the WHI study and have a much lower absolute risk of stroke.

A British Health Department spokeswoman said that the Committee on the Safety of Medicines is keeping the safety of HRT under constant review. It will review the latest findings and update its advice if necessary.