Dr. Joshua Roth, lead author of the HICOR analysis, said he does not believe that the new WHI study would change his findings. “The biggest cost savings,” he said, “were related to reduced prescriptions for combined hormone therapy and reduced breast cancer incidence and treatment costs. These costs wouldn’t be greatly impacted by long-term mortality rates.”
Different therapies, different risks
The new JAMA paper shows that participants in the original studies who had hysterectomies and took estrogen alone had a 45 percent lower risk of death specifically from breast cancer.
The new study also showed that those who took combined hormone therapy of estrogen plus progestin had a 44 percent increase in breast cancer mortality, but that result failed to reach statistical significance.
Fred Hutch’s Anderson has stated in the past that women eligible for estrogen-only therapy may want to consider it for a year or two, despite an elevated risk of stroke, if their symptoms are severe. “A woman having a few moderate hot flashes may not want to take the risk of a stroke to relieve those,” she told Fred Hutch News Service in 2014. “But for a woman waking up nightly from hot flashes or night sweats, for a woman going for days without any quality sleep, that trade-off may seem much more reasonable.”
On the other hand, for women who have not had a hysterectomy, Anderson sees combined hormone replacement therapy as a much riskier tradeoff. “Estrogen plus progestin has all of these adverse effects — breast cancer, heart disease, stroke, blood clots, dementia,” she said previously. “It’s much more risky and the adverse effects were the same in younger women in their 50s as in women in their 60s and 70s. And breast cancer in some ways is the bigger concern.”
Anderson said the risks and benefits for hormone replacement therapies should always be considered; this newest study adds another layer of information about mortality risks that a woman and her doctor can use when considering treatment options. In weighing the risks, she said, a woman may want to consider that “a stroke in your 50s can be a horribly disabling event, even if it does not translate into mortality for another 10 to 15 years.”
Harvard’s Manson also stressed that the new study does not support the use of hormone replacement therapy for the prevention of cardiovascular disease. Uncovering the link between these drugs, heart attack and stroke remains a crowning achievement of the Women’s Health Initiative, because it disproved observational studies that had been used to promote hormone therapy as enhancing heart health.
WHI studies are conducted to give patients and their doctors grounds on which to make informed choices, Manson said. “In clinical decision making, these considerations must be weighed against the impact of untreated menopausal symptoms that women experience, including impaired quality of life, disrupted sleep, reduced work productivity and increased health care expenditures.”
The WHI is funded by the National Heart, Lung, and Blood Institute; the National Institutes of Health; and the U.S. Department of Health and Human Services. Wyeth Ayerst donated the study drugs.
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Source : http://www.fredhutch.org/en/news/center-news/2017/09/death-risk-menopausal-hormone-replacement.html