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KMID : 1007320080140020081
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Journal of the Korean Society of Menopause
2008 Volume.14 No. 2 p.81 ~ p.108
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Postmenopausal Hormone Therapy and Breast Cancer
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Chang Hye-Jin
Jee Byung-Chul
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Abstract
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The Women’s Health Initiative (WHI) was initiated in 1992 as a major disease-prevention research program among postmenopausal women. The program includes a randomized controlled intervention trial involving 68,132 postmenopausal women in the age range 50∼79 at randomization and four distinct interventions including hormonal therapy (HT) for coronary heart disease prevention with breast cancer as an anticipated adverse effect. The overall profile of HT effects is not consistent with recommendations for primary prevention because of the high sensitivity to safety concerns when intervening on otherwise healthy women. WHI did not study HT in the way that it is be administered in practice-the women were older than would normally be considered for initiating HT and the study did not tailor the study hormones to the individual women. And there was a discrepancy of hazard ratio estimates for estrogen-progesterone therapy (EPT) and
estrogen (ET) alone between the clinical trials (CT) and observational studies (OS). Factors complicating interpretation of the results include differences in breast cancer risk profiles between women in CT and those in OS as well as heterogeneity in the definitions of menopause and prior use of HRT as applied by the WHI investigators to the two populations. In the WHI data, recent evidences suggest that ET reduces the overall risk of breast cancer. The risks of these outcomes are higher for EPT than for ET. The benefit-risk ratio for HT is favorable close to menopause but decreases with aging and with time since menopause in previously untreated women. WHI clinical trial contributions, challenges, and guidelines of various societies are reviewed and discussed.
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KEYWORD
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Menopause, Hormone therapy, Breast cancer, Women`s Health Initiative, WHI, Estrogen-Progesterone Therapy, EPT, Estrogen, E
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