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Conjugated estrogens and bazedoxifene in minority populations: pooled analysis of four phase 3 trials. Menopause 2016; 23:611-20. [PMID: 27163519 DOI: 10.1097/gme.0000000000000617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to compare efficacy of conjugated estrogens (CE)/bazedoxifene (BZA) for treatment of menopausal symptoms and prevention of postmenopausal osteoporosis in minorities (black/Hispanic) versus whites. METHODS In a post hoc analysis, data were pooled from 3,424 white or minority nonhysterectomized postmenopausal women randomized to CE 0.45 or 0.625 mg/BZA 20 mg or placebo in four double-blind, phase 3 Selective Estrogens, Menopause, and Response to Therapy (SMART) trials. Outcomes included hot flush frequency/severity (daily diary) in women with at least seven moderate-to-severe hot flushes per day (SMART-1, -2), vaginal cytology in women with at most 5% superficial cells (SMART-1, -3), lumbar spine and total hip bone mineral density (BMD) (SMART-1, -5), and the Menopause-Specific Quality of Life (MENQOL) questionnaire (SMART-1, -2, -3, -5). RESULTS The analysis included 2,907 white (84.9%), 315 black (9.2%), and 202 Hispanic (5.9%) women. The reduction in hot flush frequency/severity versus placebo (P < 0.05; week 12) was similar in white and minority women. In both populations, both doses significantly (P < 0.05 vs placebo) improved MENQOL vasomotor function, sexual function, and total scores at 3 months; decreased the percentage of parabasal cells at 2 years; and increased the percentage of BMD responders at 12 and 24 months. Significant differential treatment effects by race/ethnicity were observed only for effects on vaginal superficial cells at month 24 and vaginal pH at month 3. CONCLUSIONS Notwithstanding a limited sample size, CE/BZA had a similar and beneficial impact on hot flushes, MENQOL, and BMD in minorities and whites.
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102
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Bassuk SS, Manson JE. The timing hypothesis: Do coronary risks of menopausal hormone therapy vary by age or time since menopause onset? Metabolism 2016; 65:794-803. [PMID: 27085786 PMCID: PMC4834454 DOI: 10.1016/j.metabol.2016.01.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 01/07/2016] [Indexed: 02/06/2023]
Abstract
The Women's Health Initiative (WHI), a landmark randomized trial of menopausal hormone therapy (HT) for prevention of chronic disease in postmenopausal women aged 50-79, established that such therapy neither prevents coronary heart disease (CHD) nor yields a favorable balance of benefits and risks in such women as a whole. However, a nuanced look at the data from this trial, considered alongside other evidence, suggests that timing of HT initiation affects the relation between such therapy and coronary risk, as well as its overall benefit-risk balance. Estrogen may have a beneficial effect on the heart if started in early menopause, when a woman's arteries are likely to be relatively healthy, but a harmful effect if started in late menopause, when those arteries are more likely to show signs of atherosclerotic disease. However, even if HT-associated relative risks are constant across age or time since menopause onset, the low absolute risk of CHD in younger or recently menopausal women translates into low attributable risks in this group. Thus, HT initiation for relief of moderate to severe vasomotor symptoms in early menopausal patients who have a favorable coronary profile remains a viable option.
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Affiliation(s)
- Shari S Bassuk
- Division of Preventive Medicine, Brigham and Women's Hospital, 900 Commonwealth Avenue East, Boston, Massachusetts 02215.
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women's Hospital, 900 Commonwealth Avenue East, Boston, Massachusetts 02215.
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103
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Abstract
OBJECTIVE Two surveys (Harris and Rose surveys) were conducted to quantify the use of compounded hormone therapy (CHT; or bioidentical hormone therapy) among perimenopausal and postmenopausal women in the United States, to assess women's knowledge of CHT versus Food and Drug Administration (FDA)-approved hormone therapy, and to gather information on menopausal experience. METHODS The Harris survey was administered to 801 women aged 45 to 60 years who had experienced at least one menopausal symptom. The Rose survey was administered to 2,044 women aged 40 years or older who were ever users of hormone therapy. Women were queried about menopausal symptoms, hormone therapy use, and knowledge of CHT. Findings from the Rose survey were extrapolated using US Census Bureau data and prescription claims for FDA-approved hormone therapy to estimate the prevalence of CHT use. RESULTS According to extrapolations using Rose data, up to 2.5 million US women aged 40 years or older may use CHT annually, accounting for 28% to 68% of hormone therapy prescriptions. Harris data showed that 86% of women surveyed were unaware that CHT products are not FDA-approved. The Rose survey asked a subset of 1,771 women whether their hormone therapy had been personalized based on hormone levels; 21% (378) answered "yes" whereas 27% (476) did not know. In both surveys, most hormone therapy users stated that their physician had recommended the treatment. CONCLUSIONS We estimate that 1 million to 2.5 million US women aged 40 years or older use CHT. The data suggest that many women are unaware that compounded hormones have not been evaluated or approved by the FDA. Providers have an educational opportunity to ensure that women considering hormone therapy understand the risks and benefits of inadequately regulated CHT.
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104
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Kagan R, Goldstein SR, Pickar JH, Komm BS. Patient considerations in the management of menopausal symptoms: role of conjugated estrogens with bazedoxifene. Ther Clin Risk Manag 2016; 12:549-62. [PMID: 27103814 PMCID: PMC4827910 DOI: 10.2147/tcrm.s63833] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Menopausal symptoms (eg, hot flushes and vaginal symptoms) are common, often bothersome, and can adversely impact women's sexual functioning, relationships, and quality of life. Estrogen-progestin therapy was previously considered the standard care for hormone therapy (HT) for managing these symptoms in nonhysterectomized women, but has a number of safety and tolerability concerns (eg, breast cancer, stroke, pulmonary embolism, breast pain/tenderness, and vaginal bleeding) and its use has declined dramatically in the past decade since the release of the Women's Health Initiative trial results. Conjugated estrogens paired with bazedoxifene (CE/BZA) represent a newer progestin-free alternative to traditional HT for nonhysterectomized women. CE/BZA has demonstrated efficacy in reducing the frequency and severity of vasomotor symptoms and preventing loss of bone mineral density in postmenopausal women. CE/BZA provides an acceptable level of protection against endometrial hyperplasia and does not increase mammographic breast density. Compared with traditional estrogen-progestin therapy, it is associated with lower rates of breast pain/tenderness and vaginal bleeding. Patient-reported outcomes indicate that CE/BZA improves menopause-specific quality of life, sleep, some measures of sexual function (especially ease of lubrication), and treatment satisfaction. This review looks at the rationale for selection and combination of CE with BZA at the dose ratio in the approved product and provides a detailed look at the efficacy, safety, tolerability, and patient-reported outcomes from the five Phase III trials. Patient considerations in the choice between CE/BZA and traditional HT (eg, tolerability, individual symptoms, and preferences for route of administration) are also considered.
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Affiliation(s)
- Risa Kagan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Berkeley, CA, USA
- East Bay Physicians Medical Group, Berkeley, CA, USA
| | - Steven R Goldstein
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA
| | - James H Pickar
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - Barry S Komm
- Global Medical Affairs, Pfizer Inc., Collegeville, PA, USA
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105
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Pinkerton JV, Constantine GD. Compounded non-FDA-approved menopausal hormone therapy prescriptions have increased: results of a pharmacy survey. Menopause 2016; 23:359-67. [PMID: 26645819 PMCID: PMC4819678 DOI: 10.1097/gme.0000000000000567] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 09/22/2015] [Accepted: 09/22/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE From a survey of compounding pharmacists, specific questions regarding compounded menopausal hormone therapy were used to estimate compounded hormone therapy (CHT) prescribing in the United States. METHODS A national online survey was conducted by Rose Research--a market research company consisting of 12,250 US pharmacists from independent community pharmacies (ICPs) and compounding pharmacies (CPs). Pharmacists who completed the survey and met the prespecified criteria were eligible. Data from the survey were extrapolated to estimate overall CHT prescription volume and annual costs of CHT prescriptions for the United States based upon industry data from the National Community Pharmacists Association and IBISWorld. RESULTS Surveys were completed by 483 pharmacies, including 365 ICPs and 118 CPs. On the basis of the survey responses and extrapolated industry data, an estimated 26 to 33 million CHT prescriptions were filled annually, with total sales estimated at $1.3 to $1.6 billion. CPs (vs ICPs) accounted for a higher proportion of CHT prescriptions. More than half of the ICPs (52%) and CPs (75%) expected continued compounding business growth, with most predicting 5% to 25% growth within 2 years, despite the potential effect of restrictive legislation regarding compounding. CONCLUSIONS On the basis of extrapolated data from numbers of prescriptions reported by pharmacists participating in the survey, the volume of CHT seems to approach that of Food and Drug Administration (FDA)-approved menopausal hormone therapy, and growth in the CHT market is expected. Thus, physicians should educate themselves and the women consulting them about the differences between the FDA-approved and the less-tested CHT formulations. More research on the efficacy, safety, and consistency of non-FDA-approved CHT is needed.
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Affiliation(s)
- JoAnn V. Pinkerton
- Midlife Health Center, Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, VA
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106
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Palacios S, Arias L, Lavenberg J, Pan K, Mirkin S, Komm BS. Evaluation of efficacy and safety of conjugated estrogens/bazedoxifene in a Latin American population. Climacteric 2016; 19:261-7. [DOI: 10.3109/13697137.2016.1146248] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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107
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Bassuk SS, Manson JE, Lee IM, Cook NR, Christen WG, Bubes VY, Gordon DS, Copeland T, Friedenberg G, D'Agostino DM, Ridge CY, MacFadyen JG, Kalan K, Buring JE. Baseline characteristics of participants in the VITamin D and OmegA-3 TriaL (VITAL). Contemp Clin Trials 2016; 47:235-43. [PMID: 26767629 PMCID: PMC4818165 DOI: 10.1016/j.cct.2015.12.022] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/29/2015] [Accepted: 12/31/2015] [Indexed: 12/31/2022]
Abstract
Evidence for a role of supplemental vitamin D and marine omega-3 fatty acids in preventing cancer and cardiovascular disease (CVD) remains inconclusive and insufficient to inform nutritional recommendations for primary prevention. The VITamin D and Omega-A 3 TriaL (VITAL) is an ongoing nationwide, randomized, double-blind, placebo-controlled clinical trial designed to fill this knowledge gap. The study population consists of 25,874 U.S. adults without cancer or CVD at baseline, who were selected only on age (men aged ≥50 and women aged ≥55), with an oversampling of African Americans (n=5,107). In a 2 × 2 factorial design, participants were randomized to one of four supplement groups: [1] active vitamin D3 (cholecalciferol; 2000 IU/d) and active marine omega-3 fatty acids (Omacor® fish oil, eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA], 1g/d); [2] active vitamin D and omega-3 placebo; [3] vitamin D placebo and active marine omega-3 fatty acids; or [4] vitamin D placebo and omega-3 placebo. The mean length of the randomized treatment period will be 5 years. The randomization was successful, as evidenced by similar distributions of baseline demographic, health, and behavioral characteristics across treatment groups. The similar distribution of known potential confounders across treatment groups strongly suggests that unmeasured or unknown potential confounders are also equally distributed. VITAL is expected to provide important information on the benefit-risk balance of vitamin D and omega-3 fatty acid supplementation when taken for the primary prevention of cancer and CVD.
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Affiliation(s)
- Shari S Bassuk
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue East, Boston, Massachusetts 02215, United States.
| | - JoAnn E Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue East, Boston, Massachusetts 02215, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, Massachusetts 02115, United States.
| | - I-Min Lee
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue East, Boston, Massachusetts 02215, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, Massachusetts 02115, United States.
| | - Nancy R Cook
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue East, Boston, Massachusetts 02215, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, Massachusetts 02115, United States.
| | - William G Christen
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue East, Boston, Massachusetts 02215, United States.
| | - Vadim Y Bubes
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue East, Boston, Massachusetts 02215, United States.
| | - David S Gordon
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue East, Boston, Massachusetts 02215, United States.
| | - Trisha Copeland
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue East, Boston, Massachusetts 02215, United States.
| | - Georgina Friedenberg
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue East, Boston, Massachusetts 02215, United States.
| | - Denise M D'Agostino
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue East, Boston, Massachusetts 02215, United States.
| | - Claire Y Ridge
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue East, Boston, Massachusetts 02215, United States.
| | - Jean G MacFadyen
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue East, Boston, Massachusetts 02215, United States.
| | - Kate Kalan
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue East, Boston, Massachusetts 02215, United States.
| | - Julie E Buring
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 900 Commonwealth Avenue East, Boston, Massachusetts 02215, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, Massachusetts 02115, United States.
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108
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Lang K, Alexander IM, Simon J, Sussman M, Lin I, Menzin J, Friedman M, Dutwin D, Bushmakin AG, Thrift-Perry M, Altomare C, Hsu MA. The impact of multimorbidity on quality of life among midlife women: findings from a U.S. nationally representative survey. J Womens Health (Larchmt) 2016; 24:374-83. [PMID: 25973799 DOI: 10.1089/jwh.2014.4907] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Little is known about the prevalence and cumulative burden of coexisting health conditions including chronic joint and muscular pain, urinary incontinence (UI), depression, osteoporosis risk, moderate/severe vasomotor symptoms, and vulvar/vaginal atrophy (VVA). We surveyed a nationally representative U.S. sample of midlife (age 40-64 years) women to ascertain the prevalence, general health-related quality of life (HRQoL), and health-seeking behaviors associated with these six conditions. METHODS This cross-sectional, telephone survey collected data from a sample of English- and Spanish-speaking U.S. women. The survey contained demographic and menopausal status questions, and also five condition-specific symptom/disease risk-screening instruments. The EuroQol 5 dimensions (EQ-5D) questionnaire was used to measure HRQoL. Health-seeking behavior was measured based on clinician discussion of and recent treatment for each condition. RESULTS Three thousand fifty eight women (mean age 53.4 years) completed the survey. The majority were white (75.6%), married (60.5%), employed full- or part-time (59.0%), and postmenopausal (69.8%; based on self-report). The prevalence [95% confidence interval] of 0, 1, 2, and ≥3 conditions was 35.2% [33.5-36.9], 34.2% [32.5-35.9], 17.9% [16.6-19.3], and 12.7% [11.5-13.9], respectively. Osteoporosis risk (30.6%) was most prevalent, followed by VVA (27.8%) and UI (26.6%). UI and VVA coexisted most frequently (11.3%), followed by osteoporosis risk and VVA (9.8%). EQ-5D scores decreased with increasing number of illnesses (0, 1, 2, and ≥3 conditions, means: 0.92, 0.87, 0.77, 0.61, respectively; p<0.01). Health-seeking behavior varied by condition. CONCLUSION Over 25% of women surveyed had multiple coexisting conditions. Lower HRQoL was associated with multiple conditions and with each added condition.
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Affiliation(s)
- Kathleen Lang
- 1 Boston Health Economics, Inc. , Waltham, Massachusetts
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109
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Pickar JH, Amadio JM, Bernick BA, Mirkin S. Pharmacokinetic studies of solubilized estradiol given vaginally in a novel softgel capsule. Climacteric 2016; 19:181-7. [PMID: 26857443 PMCID: PMC4819841 DOI: 10.3109/13697137.2015.1136926] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective To evaluate the bioavailability and safety of a novel vaginal capsule containing solubilized bioidentical 17β-estradiol for vulvar and vaginal atrophy and compare its pharmacokinetics with that of an approved vaginal estradiol tablet in healthy postmenopausal women. Methods Two randomized, single-dose, two-way cross-over, relative bioavailability trials compared the pharmacokinetics of a solubilized vaginal estradiol softgel capsule (TX-004HR, test) with that of a vaginal estradiol tablet (Vagifem®, reference) in postmenopausal women (aged 40–65 years) at 10-μg and 25-μg doses. In each study, women were randomly assigned to receive a single dose of the test capsule or reference tablet, followed by a single dose of the alternate drug after a 14-day washout. Results Thirty-five women completed the 10-μg study and 36 completed the 25-μg study. Significantly lower systemic levels of estradiol, estrone, and estrone sulfate at both doses of the test product were observed compared with equivalent doses of the reference product, with lower AUC0-24 and Cmax and earlier tmax. No adverse events were reported in either trial. Conclusion TX-004HR, a novel estradiol vaginal softgel capsule, exhibited significantly lower systemic exposure than equivalent doses of an approved vaginal estradiol tablet at both 10-μg and 25-μg doses. Both doses of each product were safe and well-tolerated.
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Affiliation(s)
- J H Pickar
- a Columbia University Medical Center , New York , NY , USA
| | - J M Amadio
- b TherapeuticsMD , Boca Raton , FL , USA
| | | | - S Mirkin
- b TherapeuticsMD , Boca Raton , FL , USA
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110
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Gaudet MM, Barrdahl M, Lindström S, Travis RC, Auer PL, Buring JE, Chanock SJ, Eliassen AH, Gapstur SM, Giles GG, Gunter M, Haiman C, Hunter DJ, Joshi AD, Kaaks R, Khaw KT, Lee IM, Le Marchand L, Milne RL, Peeters PHM, Sund M, Tamimi R, Trichopoulou A, Weiderpass E, Yang XR, Prentice RL, Feigelson HS, Canzian F, Kraft P. Interactions between breast cancer susceptibility loci and menopausal hormone therapy in relationship to breast cancer in the Breast and Prostate Cancer Cohort Consortium. Breast Cancer Res Treat 2016; 155:531-40. [PMID: 26802016 PMCID: PMC5757510 DOI: 10.1007/s10549-016-3681-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/04/2016] [Indexed: 01/12/2023]
Abstract
Current use of menopausal hormone therapy (MHT) has important implications for postmenopausal breast cancer risk, and observed associations might be modified by known breast cancer susceptibility loci. To provide the most comprehensive assessment of interactions of prospectively collected data on MHT and 17 confirmed susceptibility loci with invasive breast cancer risk, a nested case-control design among eight cohorts within the NCI Breast and Prostate Cancer Cohort Consortium was used. Based on data from 13,304 cases and 15,622 controls, multivariable-adjusted logistic regression analyses were used to estimate odds ratios (OR) and 95 % confidence intervals (CI). Effect modification of current and past use was evaluated on the multiplicative scale. P values <1.5 × 10(-3) were considered statistically significant. The strongest evidence of effect modification was observed for current MHT by 9q31-rs865686. Compared to never users of MHT with the rs865686 GG genotype, the association between current MHT use and breast cancer risk for the TT genotype (OR 1.79, 95 % CI 1.43-2.24; P interaction = 1.2 × 10(-4)) was less than expected on the multiplicative scale. There are no biological implications of the sub-multiplicative interaction between MHT and rs865686. Menopausal hormone therapy is unlikely to have a strong interaction with the common genetic variants associated with invasive breast cancer.
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Affiliation(s)
- Mia M Gaudet
- Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA.
| | - Myrto Barrdahl
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sara Lindström
- Program in Genetic Epidemiology and Statistical Genetics, Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Ruth C Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, University of Oxford, UK
| | - Paul L Auer
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- School of Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Julie E Buring
- Divisions of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
- Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, MA, 02115, USA
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
- Core Genotyping Facility Frederick National Laboratory for Cancer Research, Gaithersburg, MD, USA
| | - A Heather Eliassen
- Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Susan M Gapstur
- Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA
| | - Graham G Giles
- Cancer Epidemiology Centre Melbourne, Cancer Council Victoria, Carlton South, Melbourne, VIC, 3004, Australia
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health, The University of Melbourne, Melbourne, VIC, 3010, Australia
- Faculty of Medicine, Monash University, Melbourne, VIC, 3800, Australia
| | - Marc Gunter
- Department of Epidemiology Biostatistics, School of Public Health, Imperial College, South Kensington Campus, London, SW7 2AZ, UK
| | - Christopher Haiman
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - David J Hunter
- Program in Genetic Epidemiology and Statistical Genetics, Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Amit D Joshi
- Program in Genetic Epidemiology and Statistical Genetics, Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP, UK
| | - I-Min Lee
- Divisions of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Loic Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, 96813, USA
| | - Roger L Milne
- Cancer Epidemiology Centre Melbourne, Cancer Council Victoria, Carlton South, Melbourne, VIC, 3004, Australia
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Petra H M Peeters
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 6 NL-3508, Stratenum, The Netherlands
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, South Kensington Campus, London, SW7 2AZ, UK
| | - Malin Sund
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, 90185, Umeå, Sweden
| | - Rulla Tamimi
- Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Antonia Trichopoulou
- Hellenic Health Foundation, 13 Kaisareias and Alexandroupoleos Street, 115 27, Athens, Greece
| | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, 9037, Tromsø, Norway
- Department of Research, Cancer Registry of Norway, Fridtjof Nansens vei 19, 0304, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels Väg 12A, 17177, Stockholm, Sweden
- Samfundet Folkhälsan, Topeliusgatan 20, 00250, Helsinki, Finland
| | - Xiaohong R Yang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Ross L Prentice
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA
| | | | - Federico Canzian
- Genomic Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Peter Kraft
- Program in Genetic Epidemiology and Statistical Genetics, Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
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111
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Salagame U, Banks E, Sitas F, Canfell K. Menopausal hormone therapy use and breast cancer risk in Australia: Findings from the New South Wales Cancer, Lifestyle and Evaluation of Risk study. Int J Cancer 2015; 138:1905-14. [DOI: 10.1002/ijc.29942] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 09/01/2015] [Indexed: 01/10/2023]
Affiliation(s)
- Usha Salagame
- Cancer Research Division, Cancer Council NSW; Woolloomooloo NSW Australia
- School of Public Health; Sydney Medical School, University of Sydney; Sydney NSW Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University; Canberra ACT Australia
- Sax Institute; Sydney NSW Australia
| | - Freddy Sitas
- School of Public Health; Sydney Medical School, University of Sydney; Sydney NSW Australia
- School of Public Health and Community Medicine; University of New South Wales; Sydney NSW Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW; Woolloomooloo NSW Australia
- School of Public Health; Sydney Medical School, University of Sydney; Sydney NSW Australia
- Prince of Wales Clinical School, University of New South Wales; Sydney NSW Australia
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112
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Abstract
OBJECTIVE Most women with moderate to severe vasomotor symptoms (VMS) are untreated. This retrospective matched-cohort study aims to evaluate the healthcare resource utilization, work loss, and cost burden associated with untreated VMS. METHODS Health insurance claims (1999-2011) were used to match (1:1) women with untreated VMS with control women using propensity score. Healthcare resource utilization, work productivity loss (disability + medically related absenteeism), and associated costs were compared between cohorts. RESULTS During the 12-month follow-up, women with untreated VMS (n = 252,273; mean age, 56 y) had significantly higher healthcare resource utilization than women in the control cohort: 82% higher for all-cause outpatient visits (95% CI, 81-83; P < 0.001) and 121% higher (95% CI, 118-124; P < 0.001) for VMS-related outpatient visits. Mean direct costs per patient per year were significantly higher for VMS women (direct cost difference, US$1,346; 95% CI, 1,249-1,449; P < 0.001). VMS women had 57% (95% CI, 51-63; P < 0.001) more indirect work productivity loss days than controls, corresponding to an incremental indirect cost per patient per year associated with untreated VMS of US$770 (95% CI, 726-816; P < 0.001). CONCLUSIONS This study shows that untreated VMS are associated with significantly higher frequency of outpatient visits and incremental direct and indirect costs.
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Benkhadra K, Mohammed K, Al Nofal A, Carranza Leon BG, Alahdab F, Faubion S, Montori VM, Abu Dabrh AM, Zúñiga Hernández JA, Prokop LJ, Murad MH. Menopausal Hormone Therapy and Mortality: A Systematic Review and Meta-Analysis. J Clin Endocrinol Metab 2015; 100:4021-8. [PMID: 26544652 DOI: 10.1210/jc.2015-2238] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
OBJECTIVES The objective was to assess the effect of menopausal hormonal therapy (MHT) on all-cause and cause-specific mortality. METHODS We conducted a comprehensive search of several databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, and Scopus) from inception until August 2013. We included randomized controlled trials (RCTs) of more than 6 months of duration comparing MHT with no treatment. Pairs of independent reviewers selected trials, assessed risk of bias and extracted data. We estimated risk ratios (RRs) and 95% confidence intervals (CIs) using the random-effects model. RESULTS We included 43 RCTs at moderate risk of bias. Meta-analysis showed no effect on mortality (RR 0.99 [95% CI, 0.94-1.05]), regardless of MHT type or history of preexisting heart disease. No association was found between MHT and cardiac death (RR 1.04 [95% CI 0.87-1.23]) or stroke (RR 1.49 [95% CI 0.95-2.31]). Estrogen plus progesterone use was associated with a likely increase in breast cancer mortality (RR 1.96 [95% CI 0.98-3.94]), whereas estrogen use was not. MHT use was not associated with mortality of other types of cancer. In 5 trials, MHT was likely started at a younger age: 2 RCTs with mean age less than 60 and 3 RCTs with MHT started less than 10 years after menopause. Meta-analysis of these 5 RCTs showed a reduction of mortality with MHT (RR 0.70 [95% CI 0.52-0.95]). CONCLUSION The current evidence suggests that MHT does not affect the risk of death from all causes, cardiac death and death from stroke or cancer. These data may be used to support clinical and policy deliberations about the role of MHT in the care of symptomatic postmenopausal women.
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Affiliation(s)
- Khalid Benkhadra
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
| | - Khaled Mohammed
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
| | - Alaa Al Nofal
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
| | - Barbara G Carranza Leon
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
| | - Fares Alahdab
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
| | - Stephanie Faubion
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
| | - Victor M Montori
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
| | - Abd Moain Abu Dabrh
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
| | - Jorge Alberto Zúñiga Hernández
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
| | - Larry J Prokop
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
| | - Mohammad Hassan Murad
- Evidence-Based Practice Research Program (K.B., K.M., F.A., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Knowledge and Evaluation Research Unit (K.B., K.M., F.A., V.M.M., A.M.A.D., M.H.M.), Mayo Clinic, Rochester, Minnesota 55905; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (K.B., K.M., A.A.N., F.A., A.M.A.D., MHM), Mayo Clinic, Rochester, Minnesota 55905; Division of Pediatric Endocrinology (A.A.N.), Mayo Clinic, Rochester, Minnesota 55905; Division of Endocrinology (B.G.C.L., V.M.M.), Mayo Clinic, Rochester, Minnesota 55905; Division of General Internal Medicine (S.F.), Women's Health Clinic, Mayo Clinic, Rochester, Minnesota 55905; Facultad de Medicina (Z.H.), Universidad Autónoma de Nuevo León, Nuevo Leon, Mexico; and Mayo Clinic Libraries (L.J.P.), Mayo Clinic, Rochester, Minnesota 55905
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Bae JM, Kim EH. Hormone Replacement Therapy and Risk of Breast Cancer in Korean Women: A Quantitative Systematic Review. J Prev Med Public Health 2015; 48:225-30. [PMID: 26429288 PMCID: PMC4592023 DOI: 10.3961/jpmph.15.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/08/2015] [Indexed: 01/11/2023] Open
Abstract
Objectives: The epidemiological characteristics of breast cancer incidence by age group in Korean women are unique. This systematic review aimed to investigate the association between hormone replacement therapy (HRT) and breast cancer risk in Korean women. Methods: We searched electronic databases such as KoreaMed, KMbase, KISS, and RISS4U as well as PubMed for publications on Korean breast cancer patients. We also conducted manual searching based on references and citations in potential papers. All of the analytically epidemiologic studies that obtained individual data on HRT exposure and breast cancer occurrence in Korean women were selected. We restricted the inclusion of case-control studies to those that included age-matched controls. Estimates of summary odds ratio (SOR) with 95% confidence intervals (CIs) were calculated using random effect models. Results: One cohort and five case-control studies were finally selected. Based on the heterogeneity that existed among the six studies (I-squared=70.2%), a random effect model was applied. The summary effect size of HRT history from the six articles indicated no statistical significance in breast cancer risk (SOR, 0.983; 95% CI, 0.620 to 1.556). Conclusions: These facts support no significant effect of HRT history in the risk of breast cancer in Korean women. It is necessary to conduct a pooled analysis.
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Affiliation(s)
- Jong-Myon Bae
- Department of Preventive Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Eun Hee Kim
- Department of Preventive Medicine, Jeju National University School of Medicine, Jeju, Korea
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Keshishian A, Wang Y, Xie L, Baser O. The economic impact of symptomatic menopause among low-socioeconomic women in the United States. Expert Rev Pharmacoecon Outcomes Res 2015; 16:305-13. [PMID: 26289732 DOI: 10.1586/14737167.2015.1073589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Menopausal symptoms have a significant negative impact on patient's quality of life and increase healthcare costs among women. METHODS This retrospective analysis used data from a U.S. national database (01 January 2008-31 December 2010). Patients with a diagnosis of menopause symptoms or a prescription claim for hormone therapy were matched to control patients. Healthcare resource utilization and costs during the 6-month follow-up period were compared. Generalized linear models were used to adjust for differences in baseline and demographic characteristics between the cohorts. RESULTS A total of 71,076 patients were included in each cohort. Patients with menopausal symptoms were more likely to have depression and anxiety and incurred significantly higher follow-up healthcare costs ($7237 vs $6739, p < 0.001) and healthcare utilization during the 6-month follow-up period. CONCLUSION Patients diagnosed with menopausal symptoms or treated with hormone therapy incurred significantly higher healthcare costs than those without menopausal symptoms or treatment.
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Affiliation(s)
- Allison Keshishian
- a 1 STATinMED Research, 211 N. 4th Avenue, Suite 2B, Ann Arbor, MI 48104, USA
| | - Yuexi Wang
- a 1 STATinMED Research, 211 N. 4th Avenue, Suite 2B, Ann Arbor, MI 48104, USA
| | - Lin Xie
- a 1 STATinMED Research, 211 N. 4th Avenue, Suite 2B, Ann Arbor, MI 48104, USA
| | - Onur Baser
- b 2 Center for Innovation and Outcomes Research, Department of Surgery, Columbia University, NY, NY.,c 3 STATinMED Research, 145 Hudson Street, Suite 200, New York, NY 10013, USA.,d 4 MEF University, Istanbul, Turkey
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116
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Rudolph A, Fasching PA, Behrens S, Eilber U, Bolla MK, Wang Q, Thompson D, Czene K, Brand JS, Li J, Scott C, Pankratz VS, Brandt K, Hallberg E, Olson JE, Lee A, Beckmann MW, Ekici AB, Haeberle L, Maskarinec G, Le Marchand L, Schumacher F, Milne RL, Knight JA, Apicella C, Southey MC, Kapuscinski MK, Hopper JL, Andrulis IL, Giles GG, Haiman CA, Khaw KT, Luben R, Hall P, Pharoah PDP, Couch FJ, Easton DF, Dos-Santos-Silva I, Vachon C, Chang-Claude J. A comprehensive evaluation of interaction between genetic variants and use of menopausal hormone therapy on mammographic density. Breast Cancer Res 2015; 17:110. [PMID: 26275715 PMCID: PMC4537547 DOI: 10.1186/s13058-015-0625-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/29/2015] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Mammographic density is an established breast cancer risk factor with a strong genetic component and can be increased in women using menopausal hormone therapy (MHT). Here, we aimed to identify genetic variants that may modify the association between MHT use and mammographic density. METHODS The study comprised 6,298 postmenopausal women from the Mayo Mammography Health Study and nine studies included in the Breast Cancer Association Consortium. We selected for evaluation 1327 single nucleotide polymorphisms (SNPs) showing the lowest P-values for interaction (P int) in a meta-analysis of genome-wide gene-environment interaction studies with MHT use on risk of breast cancer, 2541 SNPs in candidate genes (AKR1C4, CYP1A1-CYP1A2, CYP1B1, ESR2, PPARG, PRL, SULT1A1-SULT1A2 and TNF) and ten SNPs (AREG-rs10034692, PRDM6-rs186749, ESR1-rs12665607, ZNF365-rs10995190, 8p11.23-rs7816345, LSP1-rs3817198, IGF1-rs703556, 12q24-rs1265507, TMEM184B-rs7289126, and SGSM3-rs17001868) associated with mammographic density in genome-wide studies. We used multiple linear regression models adjusted for potential confounders to evaluate interactions between SNPs and current use of MHT on mammographic density. RESULTS No significant interactions were identified after adjustment for multiple testing. The strongest SNP-MHT interaction (unadjusted P int <0.0004) was observed with rs9358531 6.5kb 5' of PRL. Furthermore, three SNPs in PLCG2 that had previously been shown to modify the association of MHT use with breast cancer risk were found to modify also the association of MHT use with mammographic density (unadjusted P int <0.002), but solely among cases (unadjusted P int SNP×MHT×case-status <0.02). CONCLUSIONS The study identified potential interactions on mammographic density between current use of MHT and SNPs near PRL and in PLCG2, which require confirmation. Given the moderate size of the interactions observed, larger studies are needed to identify genetic modifiers of the association of MHT use with mammographic density.
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Affiliation(s)
- Anja Rudolph
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, D-69120, Heidelberg, Germany.
| | - Peter A Fasching
- Department of Gynaecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
- David Geffen School of Medicine, Department of Medicine Division of Hematology and Oncology, University of California at Los Angeles, Los Angeles, CA, USA.
| | - Sabine Behrens
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, D-69120, Heidelberg, Germany.
| | - Ursula Eilber
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, D-69120, Heidelberg, Germany.
| | - Manjeet K Bolla
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
| | - Qin Wang
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
| | - Deborah Thompson
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Judith S Brand
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Jingmei Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | | | | | | | - Emily Hallberg
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
| | - Janet E Olson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
| | - Adam Lee
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA.
| | - Matthias W Beckmann
- Department of Gynaecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
| | - Arif B Ekici
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
| | - Lothar Haeberle
- Department of Gynaecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
| | | | | | - Fredrick Schumacher
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Roger L Milne
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia.
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
| | - Julia A Knight
- Prosserman Centre for Health Research, Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, Toronto, Canada.
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Carmel Apicella
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
| | - Melissa C Southey
- Department of Pathology, The University of Melbourne, Melbourne, Australia.
| | - Miroslav K Kapuscinski
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
| | - Irene L Andrulis
- Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, Toronto, Canada.
- Department of Molecular Genetics, University of Toronto, Toronto, Canada.
| | - Graham G Giles
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia.
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
| | - Christopher A Haiman
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Kay-Tee Khaw
- MRC Centre for Nutritional Epidemiology in Cancer Prevention and Survival (CNC), University of Cambridge, Cambridge, UK.
| | - Robert Luben
- Clinical Gerontology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Paul D P Pharoah
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK.
| | - Fergus J Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK.
| | - Isabel Dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - Celine Vachon
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, D-69120, Heidelberg, Germany.
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Parks DM, Levine J. Helping Women Understand Treatment Options for Vulvar and Vaginal Atrophy. Nurs Womens Health 2015; 19:298-312. [PMID: 26264795 DOI: 10.1111/1751-486x.12216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Vulvar and vaginal atrophy (VVA) is a common and progressive medical condition in postmenopausal women. The REVIVE (REal Women's VIews of Treatment Options for Menopausal Vaginal ChangEs) survey assessed knowledge about VVA and its impact in 3,046 postmenopausal U.S. women, and recorded women's attitudes about their interactions with health care providers and about available treatments. REVIVE identified poor disease awareness and understanding among women, failure of health care professionals to evaluate women for VVA signs and symptoms, low treatment rates and concerns about the safety and efficacy of available therapies. Strategies to address these needs include proactive screening, education for women and clinicians about VVA and recommendations for treatment and follow-up.
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Freedman MA. Perceptions of dyspareunia in postmenopausal women with vulvar and vaginal atrophy: findings from the REVIVE survey. ACTA ACUST UNITED AC 2015; 10:445-54. [PMID: 25259904 DOI: 10.2217/whe.14.29] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Symptoms of vulvar and vaginal atrophy (VVA), including dyspareunia and vaginal dryness, have a distinct negative impact on a woman's quality of life. The REVIVE survey highlighted the lack of awareness of VVA symptoms among postmenopausal women with vaginal symptoms, with many women reluctant to initiate discussions with their healthcare professionals despite the presence of vaginal symptoms. The REVIVE survey also provided insights into women's views of VVA treatments. Women reported displeasure with the vaginal administration route, lack of symptom relief with over-the-counter products, and concerns about the safety of estrogen therapies. With the high prevalence of VVA, obstetricians/gynecologists should become vigilant in identifying women with VVA by implementing screening and discussion of symptoms during routine office visits - providing patients with information about appropriate therapies based on the severity and impact of symptoms, keeping in mind individual preferences and perceptions.
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Abstract
The impact of the findings from the Women's Health Initiative trial of estrogen plus progestin cannot be attributed to any real or imagined conflicts of interest between government, researchers, and journals. Rather, the findings overturned decades of dogma in part promoted by the pharmaceutical industry, and the reaction to these unexpected findings was in direct proportion to their importance in reversing a misguided practice of prescribing the drug for chronic disease prevention. The findings have been widely accepted, as shown by the sustained subsequent reduction in prescriptions. However, conflicts of interest may influence a minority unwilling to accept the findings. The decrease in the use of a drug with an adverse risk profile for prevention of chronic disease is a public good.
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O'Brien KM, Fei C, Sandler DP, Nichols HB, DeRoo LA, Weinberg CR. Hormone therapy and young-onset breast cancer. Am J Epidemiol 2015; 181:799-807. [PMID: 25698646 DOI: 10.1093/aje/kwu347] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 11/17/2014] [Indexed: 11/14/2022] Open
Abstract
Estrogen plus progestin hormone therapy (HT) is associated with an increased risk of postmenopausal breast cancer, but few studies have examined the impact of HT use on the risk of breast cancer in younger women. We assessed the association between estrogen plus progestin HT or unopposed estrogen HT and young-onset breast cancer using data from the Two Sister Study (2008-2010), a sister-matched study of 1,419 cases diagnosed with breast cancer before the age of 50 years and 1,665 controls. We assessed exposures up to a family-specific index age to ensure comparable opportunities for exposures and used propensity scores to control for birth cohort effects on HT use. Ever HT use was uncommon (7% and 11% in cases and controls, respectively). Use of estrogen plus progestin was not associated with an increased risk of young-onset breast cancer (odds ratio = 0.80, 95% confidence interval: 0.41, 1.59). Unopposed estrogen use was inversely associated with the risk of young-onset breast cancer (odds ratio = 0.58, 95% confidence interval: 0.34, 0.99). Duration of use, age at first use, and recency of use did not modify these associations.
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Mirkin S, Amadio JM, Bernick BA, Pickar JH, Archer DF. 17β-Estradiol and natural progesterone for menopausal hormone therapy: REPLENISH phase 3 study design of a combination capsule and evidence review. Maturitas 2015; 81:28-35. [DOI: 10.1016/j.maturitas.2015.02.266] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 02/27/2015] [Indexed: 11/29/2022]
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Pardini D. [Hormone replacement therapy in menopause]. ACTA ACUST UNITED AC 2015; 58:172-81. [PMID: 24830594 DOI: 10.1590/0004-2730000003044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 11/27/2013] [Indexed: 11/22/2022]
Abstract
Although estrogen has been clinically available for more than six decades, women have been confused by different opinions regarding the risks and benefits of menopausal hormone therapy (HT), estrogen therapy (ET), and estrogen-progestin therapy (EPT). The publication of randomized controlled trials (RCTs), notably, the Heart and Estrogen/progestin Replacement Study (HERS) and Women's Health Initiative (WHI), has intensified the risk vs. benefit controversy. Millions of women are treated with HT for relief of menopausal symptoms, including vasomotor flushes and sweats, for which estrogen is uniquely and highly effective. Others may continue longer-term treatment in the hope that HT will help to prevent chronic disease. The preservation of bone mass with continuing estrogen therapy and reduction of subsequent risk of fracture is well established. Observational studies of the metabolic and vascular effects of estrogens have suggested a potential benefit in reducing the risk of vascular disease, but recently published randomized controlled trials demonstrated no evidence of benefit in women with established vascular disease or in apparently healthy women. The increased risks of breast cancer and thromboembolic disease have been confirmed in these trials, with evidence of increased risk of stroke. The absolute incidence of an adverse event is low, and the risk of stroke in an individual woman in a single year is very small, but with long-term use, the risks are cumulative over time. The risk-benefit balance needs to be individualized for each woman.
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Affiliation(s)
- Dolores Pardini
- Ambulatório de Menopausa, Escola Paulista de Medicina, Universidade Federal de São Paulo
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123
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Chlebowski RT, Anderson GL. Menopausal hormone therapy and breast cancer mortality: clinical implications. Ther Adv Drug Saf 2015; 6:45-56. [PMID: 25922653 PMCID: PMC4406918 DOI: 10.1177/2042098614568300] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The Women's Health Initiative (WHI) has conducted two randomized, placebo-controlled clinical trials to evaluate the influence of menopausal hormone therapy on chronic disease risk. Estrogen plus progestin was evaluated in 16,608 postmenopausal women without prior hysterectomy during 5.6 years' intervention. In that setting, combined hormone therapy use significantly increased breast cancer incidence and interfered with breast cancer detection. The breast cancers were not limited to estrogen receptor positive, favorable prognosis cancers and were identified at more advanced stage. As a result, deaths from breast cancer were significantly increased by estrogen plus progestin use. While the absolute breast cancer risk for relatively short term (2-4 years) use of combined hormone therapy is small, on a population basis a therapy which nearly doubles deaths from breast cancer requires cautious use. Estrogen alone was evaluated in 10,739 postmenopausal women with prior hysterectomy during 7.1 years' intervention. There was an overall reduction of breast cancer incidence seen with estrogen alone use and a suggestion that the effect on risk was more pronounced in women initiating hormone therapy further from menopause. Nonetheless, women with prior hysterectomy can be assured that short duration estrogen alone use for climacteric symptom management is relatively safe. Neither estrogen plus progestin nor estrogen alone should be used for chronic disease risk reduction. The safety of duration of use on chronic disease risk longer than in the WHI clinical trials is not defined.
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Affiliation(s)
- Rowan T Chlebowski
- Los Angeles Biomedical Research Institute at Harbor, UCLA Medical Center, 1124 W. Carson St., Torrance, CA 90502, USA
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Gangnon RE, Sprague BL, Stout NK, Alagoz O, Weedon-Fekjær H, Holford TR, Trentham-Dietz A. The contribution of mammography screening to breast cancer incidence trends in the United States: an updated age-period-cohort model. Cancer Epidemiol Biomarkers Prev 2015; 24:905-12. [PMID: 25787716 DOI: 10.1158/1055-9965.epi-14-1286] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/18/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The impact of screening mammography on breast cancer incidence is difficult to disentangle from cohort- and age-related effects on incidence. METHODS We developed an age-period-cohort model of ductal carcinoma in situ (DCIS) and invasive breast cancer incidence in U.S. females using cancer registry data. Five functions were included in the model to estimate stage-specific effects for age, premenopausal birth cohorts, postmenopausal birth cohorts, period (for all years of diagnosis), and a mammography period effect limited to women ages ≥ 40 years after 1982. Incidence with and without the mammography period effect was calculated. RESULTS More recent birth cohorts have elevated underlying risk compared with earlier cohorts for both pre- and postmenopausal women. Comparing models with and without the mammography period effect showed that overall breast cancer incidence would have been 23.1% lower in the absence of mammography in 2010 (95% confidence intervals, 18.8-27.4), including 14.7% (9.5-19.3) lower for invasive breast cancer and 54.5% (47.4-59.6) lower for DCIS. Incidence of distant-staged breast cancer in 2010 would have been 29.0% (13.1-48.1) greater in the absence of mammography screening. CONCLUSIONS Mammography contributes to markedly elevated rates of DCIS and early-stage invasive cancers, but also contributes to substantial reductions in the incidence of metastatic breast cancer. IMPACT Mammography is an important tool for reducing the burden of breast cancer, but future work is needed to identify risk factors accounting for increasing underlying incidence and to distinguish between indolent and potentially lethal early-stage breast cancers that are detected via mammography.
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Affiliation(s)
- Ronald E Gangnon
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin. Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin. Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin
| | - Brian L Sprague
- Department of Surgery and Vermont Cancer Center, University of Vermont, Burlington, Vermont
| | - Natasha K Stout
- Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
| | - Oguz Alagoz
- Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin. Department of Industrial and System Engineering, University of Wisconsin, Madison, Wisconsin
| | - Harald Weedon-Fekjær
- Oslo Center for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | | | - Amy Trentham-Dietz
- Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin. Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin.
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Hormone therapy use in women veterans accessing veterans health administration care: a national cross-sectional study. J Gen Intern Med 2015; 30:169-75. [PMID: 25373833 PMCID: PMC4314474 DOI: 10.1007/s11606-014-3073-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 09/19/2014] [Accepted: 10/15/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED The majority of women Veterans using VA (Veterans Administration) care fall in the 45-65 year-old age range. Understanding how menopause is managed in this group is of importance to optimizing their health. OBJECTIVE National population estimates showed a prevalence of hormone therapy (HT) use by women over 45 years of 4.7 % (2009-2010). Our study described the frequency of HT use among women Veterans in VA, and examined whether mental health (MH) was predictive of HT use. DESIGN This was a cross-sectional analysis of national VA administrative data for fiscal year 2009. PARTICIPANTS Women Veterans over the age of 45 (N = 157,195) accessing VA outpatient care were included in the analysis. MAIN MEASURES Logistic regression analyses using HT use as the dependent variable. KEY RESULTS Mean age was 59.4 years (SD =12.2, range =46-110), and 16,227 (10.3 %) of all women used HT. Hysterectomy (OR 3.99 [3.53, 4.49]) and osteoporosis (1.34 [1.27, 1.42]) were the strongest medical indicators of HT use. A total of 49,557 (31.5 %) women in the sample received at least one primary diagnosis of a MH disorder and were more likely to use HT than women with no MH diagnoses (unadjusted OR 1.56, 95 % CI [1.50, 1.61]). Women Veterans with a mood disorder (depression/bipolar) or anxiety disorder [post-traumatic stress disorder (PTSD), other anxiety diagnoses] were more likely to use HT after controlling for demographics and medical comorbidity. CONCLUSION The prevalence of HT use among women Veterans using VA is more than twice that of the general population. Prior work suggested that women Veterans were discontinuing HT at comparable rates, but these data demonstrate that decline in VA HT use has not kept pace with that of civilian medical care. The association of MH diagnosis with HT use suggests that MH plays an important role in VA rates. Further study is needed to understand contributing patient and provider factors.
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126
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Genazzani AR, Komm BS, Pickar JH. Emerging hormonal treatments for menopausal symptoms. Expert Opin Emerg Drugs 2015; 20:31-46. [DOI: 10.1517/14728214.2015.986093] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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127
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Sighoko D, Fackenthal JD, Hainaut P. Changes in the pattern of breast cancer burden among African American women: evidence based on 29 states and District of Columbia during 1998 to 2010. Ann Epidemiol 2015; 25:15-25.e10. [DOI: 10.1016/j.annepidem.2014.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/11/2014] [Accepted: 09/13/2014] [Indexed: 11/17/2022]
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Faubion SS, Kapoor E, Kuhle CL, Sood R, Thielen JM, Miller VM. Recommendations for hormone therapy in hysterectomized women: importance of new data in clinical management. Expert Rev Endocrinol Metab 2015; 10:55-63. [PMID: 30289039 DOI: 10.1586/17446651.2015.957182] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Women with a prior hysterectomy with and without oophorectomy represent special cohorts among those who require menopausal hormone therapy (HT), as a progestogen is not required for endometrial protection. This is relevant in light of recent research demonstrating superiority of estrogen therapy alone compared with estrogen plus a progestogen with respect to breast cancer risk and perhaps even cardiovascular protection. No longer is it appropriate to lump all HT regimens together when advising patients. Unfortunately, there is a general reluctance in the healthcare community to prescribe HT even a decade after publication of the results of the Women's Health Initiative trial. However, with subsequent research showing a favorable benefit/risk balance of short-term estrogen therapy in symptomatic, recently menopausal women, especially those who have undergone hysterectomy with oophorectomy, the need for educating patients and providers on the matter cannot be overemphasized.
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Affiliation(s)
- Stephanie S Faubion
- a 1 Department of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Ekta Kapoor
- a 1 Department of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Carol L Kuhle
- b 2 Department of Preventive Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Richa Sood
- a 1 Department of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Jacqueline M Thielen
- a 1 Department of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Virginia M Miller
- c 3 Department of Surgery, Mayo Clinic, 4-62 Medical Sciences Building, Rochester, MN 55905, USA
- d 4 Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
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129
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Bassuk SS, Manson JE. Oral contraceptives and menopausal hormone therapy: relative and attributable risks of cardiovascular disease, cancer, and other health outcomes. Ann Epidemiol 2014. [PMID: 25534509 DOI: 10.1016/-j.annepi-dem.2014.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To summarize the relative risks (RRs) and attributable risks (ARs) of major health outcomes associated with use of combined oral contraceptives (OCs) and menopausal hormone therapy (HT). METHODS For OCs, measures of association are from meta-analyses of observational studies. For HT, these measures are from the Women's Health Initiative, a large randomized trial of HT for chronic disease prevention in postmenopausal women aged 50 to 79 years. RESULTS Current OC use increases risks of venous thromboembolism and ischemic stroke. However, women of reproductive age are at low baseline risk, so the ARs are small. OC use also increases risk of breast and liver cancer and reduces risk of ovarian, endometrial, and colorectal cancer; the net effect is a modest reduction in total cancer. The Women's Health Initiative results show that HT does not prevent coronary events or overall chronic disease in postmenopausal women as a whole. Subgroup analyses suggest that timing of HT initiation influences the relation between such therapy and coronary risk, and its overall risk-benefit balance, with more favorable effects (on a relative scale) in younger or recently menopausal women than in older women or those further past the menopausal transition. However, even if the RR do not vary by these characteristics, the low absolute baseline risks of younger or recently menopausal women translate into low ARs in this group. CONCLUSIONS OC and HT can safely be used for contraception and treatment of vasomotor symptoms, respectively, by healthy women at low baseline risk for cardiovascular disease and breast cancer.
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Affiliation(s)
- Shari S Bassuk
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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130
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Bassuk SS, Manson JE. Oral contraceptives and menopausal hormone therapy: relative and attributable risks of cardiovascular disease, cancer, and other health outcomes. Ann Epidemiol 2014; 25:193-200. [PMID: 25534509 DOI: 10.1016/j.annepidem.2014.11.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 11/09/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE To summarize the relative risks (RRs) and attributable risks (ARs) of major health outcomes associated with use of combined oral contraceptives (OCs) and menopausal hormone therapy (HT). METHODS For OCs, measures of association are from meta-analyses of observational studies. For HT, these measures are from the Women's Health Initiative, a large randomized trial of HT for chronic disease prevention in postmenopausal women aged 50 to 79 years. RESULTS Current OC use increases risks of venous thromboembolism and ischemic stroke. However, women of reproductive age are at low baseline risk, so the ARs are small. OC use also increases risk of breast and liver cancer and reduces risk of ovarian, endometrial, and colorectal cancer; the net effect is a modest reduction in total cancer. The Women's Health Initiative results show that HT does not prevent coronary events or overall chronic disease in postmenopausal women as a whole. Subgroup analyses suggest that timing of HT initiation influences the relation between such therapy and coronary risk, and its overall risk-benefit balance, with more favorable effects (on a relative scale) in younger or recently menopausal women than in older women or those further past the menopausal transition. However, even if the RR do not vary by these characteristics, the low absolute baseline risks of younger or recently menopausal women translate into low ARs in this group. CONCLUSIONS OC and HT can safely be used for contraception and treatment of vasomotor symptoms, respectively, by healthy women at low baseline risk for cardiovascular disease and breast cancer.
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Affiliation(s)
- Shari S Bassuk
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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131
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Sexual function in women on estradiol or venlafaxine for hot flushes: a randomized controlled trial. Obstet Gynecol 2014; 124:233-241. [PMID: 25004335 DOI: 10.1097/aog.0000000000000386] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate sexual function in midlife women taking low-dose oral estradiol or venlafaxine for hot flushes. METHODS In an 8-week randomized controlled trial among women aged 40-62 years, sexual function was compared between 0.5 mg oral estradiol per day or 75 mg venlafaxine per day (both compared with a placebo). Measures included composite and six domain scores from the Female Sexual Function Index and sexually related personal distress. RESULTS Participants were aged 54.6 years (standard deviation [SD] 3.8) years, 59% white, with 8.1 (SD 5.3) daily hot flushes. Median composite baseline Female Sexual Function Index score was 16.3 (SD 11.9, n=256) for all women and 21.7 (SD 9.3, n=198) among sexually active women. Composite mean Female Sexual Function Index change from baseline to week 8 was 1.4 (95% confidence interval [CI] -0.4 to 3.2) for estradiol, 1.1 (95% CI -0.5 to 2.7) for venlafaxine, and -0.3 (95% CI -1.6 to 1.0) for placebo. Composite Female Sexual Function Index and sexually related distress change from baseline did not differ between estradiol and placebo (P=.38, P=.30) or venlafaxine and placebo (P=.79, P=.48). Among sexually active women, Female Sexual Function Index domain score change from baseline differences (active compared with placebo) in desire was 0.3 (95% CI 0.0-0.6) for estradiol, -0.6 (95% CI -1.2 to 0.0) in orgasm for venlafaxine, and 0.9 (95% CI 0.2-1.6) in penetration pain for venlafaxine. No women reported adverse events related to sexual dysfunction. CONCLUSION Overall sexual function among nondepressed midlife women experiencing hot flushes did not change over 8 weeks with low-dose oral estradiol or venlafaxine (compared with placebo), although a subtle increase in desire (estradiol) and decreases in orgasm and pain (venlafaxine) may exist. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, www.clinicaltrials.gov, NCT01418209. LEVEL OF EVIDENCE I.
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Jewett PI, Gangnon RE, Trentham-Dietz A, Sprague BL. Trends of postmenopausal estrogen plus progestin prevalence in the United States between 1970 and 2010. Obstet Gynecol 2014; 124:727-733. [PMID: 25198271 PMCID: PMC4172523 DOI: 10.1097/aog.0000000000000469] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate long term trends in estrogen-progestin prevalence for the U.S. female population by year and age. METHODS We integrated data on oral estrogen-progestin use from the National Health and Nutrition Examination Survey 1999-2010 with data from the National Prescription Audit 1970-2003. Distributions of estrogen-progestin by age from the National Health and Nutrition Examination Survey were applied to the prescription data, and calibration and interpolation procedures were used to generate estrogen-progestin prevalence estimates by single year of age and single calendar year for 1970-2010. RESULTS Estimated prevalence of oral estrogen-progestin was below 0.5% in the 1970s, began to rise in the early 1980s, and almost tripled between 1990 and the late 1990s. The age-adjusted prevalence for women aged 45-64 years peaked at 13.5% in 1999 with highest use among 57-year-old women (23.2%). Prevalence of estrogen-progestin use declined dramatically in the early 2000s with only 2.7% of women aged 45-64 years using estrogen-progestin in 2010, which is comparable to prevalence levels in the mid-1980s. CONCLUSION The dramatic rise and fall of estrogen-progestin use over the past 40 years provides an illuminating case study of prescription practices before, during, and after the development of evidence regarding benefits and harms. LEVEL OF EVIDENCE : II.
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Affiliation(s)
- Patricia I. Jewett
- Department of Population Health Science, University of Wisconsin, Madison, WI 53726
- University of Wisconsin Carbone Cancer Center, Madison, WI 53726
| | - Ronald E. Gangnon
- Department of Population Health Science, University of Wisconsin, Madison, WI 53726
- Department of Biostatistics and Medical Informatics, University of Madison, WI 53726
- University of Wisconsin Carbone Cancer Center, Madison, WI 53726
| | - Amy Trentham-Dietz
- Department of Population Health Science, University of Wisconsin, Madison, WI 53726
- University of Wisconsin Carbone Cancer Center, Madison, WI 53726
| | - Brian L. Sprague
- Department of Surgery and Vermont Cancer Center, University of Vermont, Burlington, VT 05401
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Constantine G, Graham S, Portman DJ, Rosen RC, Kingsberg SA. Female sexual function improved with ospemifene in postmenopausal women with vulvar and vaginal atrophy: results of a randomized, placebo-controlled trial. Climacteric 2014; 18:226-32. [PMID: 25252699 PMCID: PMC4389697 DOI: 10.3109/13697137.2014.954996] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Ospemifene is a non-estrogen, tissue selective estrogen receptor agonist/antagonist, or selective estrogen receptor modulator, recently approved for the treatment of dyspareunia, a symptom of vulvar and vaginal atrophy (VVA), due to menopause. Postmenopausal dyspareunia is often associated with female sexual dysfunction (FSD). In this report, we present data that demonstrate the effect of ospemifene 60 mg/day on FSD assessed by the Female Sexual Function Index (FSFI), a widely used tool with six domains (Arousal, Desire, Orgasm, Lubrication, Satisfaction, and Pain). Methods A phase-3, randomized, double-blind, 12-week trial (n = 919) compared the efficacy and safety of oral ospemifene 60 mg/day vs. placebo in postmenopausal women with VVA in two strata based on self-reported, most bothersome symptom of either dyspareunia or dryness. Primary data were published previously. We report herein pre-specified secondary efficacy endpoints analyses, including changes from baseline to Weeks 4 and 12 for FSFI total and domain scores as well as serum hormone levels. Results Ospemifene 60 mg/day demonstrated a significantly greater FSFI total score improvement vs. placebo at Week 4 (p < 0.001). Improvement in FSFI scores continued to Week 12 (p < 0.001). At Week 4, the FSFI domains of Sexual Pain, Arousal, and Desire were significantly improved with ospemifene vs. placebo; at Week 12, improvements in all domains were significant (p < 0.05). Changes in serum hormones were minor and uncorrelated with changes in sexual functioning. Conclusion In a large, randomized, double-blind, placebo-controlled trial, ospemifene 60 mg/day significantly improved FSD in women with VVA. Consistent effects across FSFI domains were observed.
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Poluzzi E, Piccinni C, Raschi E, Rampa A, Recanatini M, De Ponti F. Phytoestrogens in postmenopause: the state of the art from a chemical, pharmacological and regulatory perspective. Curr Med Chem 2014; 21:417-36. [PMID: 24164197 PMCID: PMC3963458 DOI: 10.2174/09298673113206660297] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 08/01/2013] [Accepted: 10/04/2013] [Indexed: 11/22/2022]
Abstract
Phytoestrogens represent a diverse group of non-steroidal natural products, which seem to have some oestrogenic effects and are often marketed as food supplements. Population exposed to phytoestrogens is potentially increasing, in part because an unfavourable risk-benefit profile of Hormone Replacement Therapy (HRT) for prolonged treatments (e.g., osteoporosis prevention) highlighted by the publication of the Women Health Initiative (WHI) trial in 2002, but also because many post-menopausal women often perceived phytoestrogens in food supplements as a safer alternative than HRT. Despite of increasing preclinical and clinical studies in the past decade, appealing evidence is still lacking to support the overall positive risk-benefit profile of phytoestrogens. Their status as food supplements seems to discourage studies to obtain new evidence, and the chance to buy them by user's initiative make it difficult to survey their prevalence and pattern of use. The aim of the present review is to: (a) outline the clinical scenario underlying the increased interest on phytoestrogens, by overviewing the evolution of the evidence on HRT and its main therapeutic goals (e.g., menopausal symptoms relief, chemoprevention, osteoporosis prevention); (b) address the chemical and pharmacological features (e.g. chemical structure, botanical sources, mechanism of action) of the main compounds (e.g., isoflavones, lignans, coumestans); (c) describe the clinical evidence on potential therapeutic applications; (d) put available evidence on their riskbenefit profile in a regulatory perspective, in light of the recent regulation on health claims of food supplements.
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Affiliation(s)
| | | | | | | | | | - Fabrizio De Ponti
- Pharmacology Unit Department of Medical and Surgical Sciences Via Irnerio, 48 I-40126 Bologna BO Italy.
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135
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Abstract
Hysterectomy remains the most common major gynecological surgery. Postoperative sexual function is a concern for many women and their partners. In this respect, a beneficial effect of hysterectomy for benign disease independent of surgical techniques or removal of the cervix has been demonstrated in the past decade by the majority of studies. For about 20 % of women, deteriorated sexual function has been reported and current research is attempting to identify mechanisms and predictive factors explaining these postoperative changes. Alternative treatments of benign uterine disorders or uterus preserving surgery for genital prolapse appeared to have similar outcomes in terms of sexual function. Concomitant oophorectomy had negative effects on sexual function and long-term health, particularly in premenopausal women. This may not be reversed by estrogen replacement. Hysterectomy performed for malignancy had a detrimental effect on sexual function. Individualized risk assessment and information should be aimed at during preoperative decision making.
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136
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Lobo RA. What the future holds for women after menopause: where we have been, where we are, and where we want to go. Climacteric 2014; 17 Suppl 2:12-7. [DOI: 10.3109/13697137.2014.944497] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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137
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Killelea BK, Long JB, Chagpar AB, Ma X, Wang R, Ross JS, Gross CP. Evolution of breast cancer screening in the Medicare population: clinical and economic implications. J Natl Cancer Inst 2014; 106:dju159. [PMID: 25031307 DOI: 10.1093/jnci/dju159] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Newer approaches to mammography, including digital image acquisition and computer-aided detection (CAD), and adjunct imaging (e.g., magnetic resonance imaging [MRI]) have diffused into clinical practice. The impact of these technologies on screening-related cost and outcomes remains undefined, particularly among older women. METHODS Using the Surveillance, Epidemiology, and End Results-Medicare linked database, we constructed two cohorts of women without a history of breast cancer and followed each cohort for 2 years. We compared the use and cost of screening mammography including digital mammography and CAD, adjunct procedures including breast ultrasound, MRI, and biopsy between the period of 2001 and 2002 and the period of 2008 and 2009 using χ(2) and t test. We also assessed the change in breast cancer stage and incidence rates using χ(2) and Poisson regression. All statistical tests were two-sided. RESULTS There were 137150 women (mean age = 76.0 years) in the early cohort (2001-2002) and 133097 women (mean age = 77.3 years) in the later cohort (2008-2009). The use of digital image acquisition for screening mammography increased from 2.0% in 2001 and 2002 to 29.8% in 2008 and 2009 (P < .001). CAD use increased from 3.2% to 33.1% (P < .001). Average screening-related cost per capita increased from $76 to $112 (P < .001), with annual national fee-for-service Medicare spending increasing from $666 million to $962 million. There was no statistically significant change in detection rates of early-stage tumors (2.45 vs 2.57 per 1000 person-years; P = .41). CONCLUSIONS Although breast cancer screening-related costs increased substantially from 2001 through 2009 among Medicare beneficiaries, a clinically significant change in stage at diagnosis was not observed.
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Affiliation(s)
- Brigid K Killelea
- Affiliations of authors: Department of Surgery (BKK, ABC), Section of General Internal Medicine (JBL, JSR, CPG), and Department of Epidemiology and Public Health (XM, RW), Yale University School of Medicine, New Haven, CT; Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT (BKK, JBL, ABC, XM, RW, JSR, CPG); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (JSR)
| | - Jessica B Long
- Affiliations of authors: Department of Surgery (BKK, ABC), Section of General Internal Medicine (JBL, JSR, CPG), and Department of Epidemiology and Public Health (XM, RW), Yale University School of Medicine, New Haven, CT; Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT (BKK, JBL, ABC, XM, RW, JSR, CPG); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (JSR)
| | - Anees B Chagpar
- Affiliations of authors: Department of Surgery (BKK, ABC), Section of General Internal Medicine (JBL, JSR, CPG), and Department of Epidemiology and Public Health (XM, RW), Yale University School of Medicine, New Haven, CT; Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT (BKK, JBL, ABC, XM, RW, JSR, CPG); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (JSR)
| | - Xiaomei Ma
- Affiliations of authors: Department of Surgery (BKK, ABC), Section of General Internal Medicine (JBL, JSR, CPG), and Department of Epidemiology and Public Health (XM, RW), Yale University School of Medicine, New Haven, CT; Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT (BKK, JBL, ABC, XM, RW, JSR, CPG); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (JSR)
| | - Rong Wang
- Affiliations of authors: Department of Surgery (BKK, ABC), Section of General Internal Medicine (JBL, JSR, CPG), and Department of Epidemiology and Public Health (XM, RW), Yale University School of Medicine, New Haven, CT; Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT (BKK, JBL, ABC, XM, RW, JSR, CPG); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (JSR)
| | - Joseph S Ross
- Affiliations of authors: Department of Surgery (BKK, ABC), Section of General Internal Medicine (JBL, JSR, CPG), and Department of Epidemiology and Public Health (XM, RW), Yale University School of Medicine, New Haven, CT; Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT (BKK, JBL, ABC, XM, RW, JSR, CPG); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (JSR)
| | - Cary P Gross
- Affiliations of authors: Department of Surgery (BKK, ABC), Section of General Internal Medicine (JBL, JSR, CPG), and Department of Epidemiology and Public Health (XM, RW), Yale University School of Medicine, New Haven, CT; Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT (BKK, JBL, ABC, XM, RW, JSR, CPG); Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (JSR).
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138
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Lindh-Åstrand L, Hoffmann M, Hammar M, Spetz Holm AC. Hot flushes, hormone therapy and alternative treatments: 30 years of experience from Sweden. Climacteric 2014; 18:53-62. [DOI: 10.3109/13697137.2014.915516] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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139
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Wysocki S, Kingsberg S, Krychman M. Management of Vaginal Atrophy: Implications from the REVIVE Survey. CLINICAL MEDICINE INSIGHTS. REPRODUCTIVE HEALTH 2014; 8:23-30. [PMID: 24987271 PMCID: PMC4071759 DOI: 10.4137/cmrh.s14498] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 03/25/2014] [Accepted: 04/02/2014] [Indexed: 12/30/2022]
Abstract
Vulvar and vaginal atrophy (VVA) is a chronic and progressive medical condition common in postmenopausal women. Symptoms of VVA such as dyspareunia, vaginal dryness, irritation, and itching can negatively impact sexual function and quality of life. The REVIVE (REal Women’s VIews of Treatment Options for Menopausal Vaginal ChangEs) survey assessed knowledge about VVA and recorded attitudes about interactions with healthcare providers (HCPs) and available treatment options for VVA. The REVIVE survey identified unmet needs of women with VVA symptoms such as poor understanding of the condition, poor communication with HCPs despite the presence of vaginal symptoms, and concerns about the safety, convenience, and efficacy of available VVA treatments. HCPs can address these unmet needs by proactively identifying patients with VVA and educating them about the condition as well as discussing treatment preferences and available therapies for VVA.
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Affiliation(s)
| | | | - Michael Krychman
- Southern California Center for Sexual Health and Survivorship Medicine, Newport Beach, CA, USA
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140
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Roth JA, Etzioni R, Waters TM, Pettinger M, Rossouw JE, Anderson GL, Chlebowski RT, Manson JE, Hlatky M, Johnson KC, Ramsey SD. Economic return from the Women's Health Initiative estrogen plus progestin clinical trial: a modeling study. Ann Intern Med 2014; 160:594-602. [PMID: 24798522 PMCID: PMC4157355 DOI: 10.7326/m13-2348] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The findings of the Women's Health Initiative (WHI) estrogen plus progestin (E+P) trial led to a substantial reduction in use of combined hormone therapy (cHT) among postmenopausal women in the United States. The economic effect of this shift has not been evaluated relative to the trial's $260 million cost (2012 U.S. dollars). OBJECTIVE To estimate the economic return from the WHI E+P trial. DESIGN Decision model to simulate health outcomes for a "WHI scenario" with observed cHT use and a "no-WHI scenario" with cHT use extrapolated from the pretrial period. DATA SOURCES Primary analyses of WHI outcomes, peer-reviewed literature, and government sources. TARGET POPULATION Postmenopausal women in the United States, aged 50 to 79 years, who did not have a hysterectomy. TIME HORIZON 2003 to 2012. PERSPECTIVE Payer. INTERVENTION Combined hormone therapy. OUTCOME MEASURES Disease incidence, expenditure, quality-adjusted life-years, and net economic return. RESULTS OF BASE-CASE ANALYSIS The WHI scenario resulted in 4.3 million fewer cHT users, 126,000 fewer breast cancer cases, 76,000 fewer cardiovascular disease cases, 263,000 more fractures, 145,000 more quality-adjusted life-years, and expenditure savings of $35.2 billion. The corresponding net economic return of the trial was $37.1 billion ($140 per dollar invested in the trial) at a willingness-to-pay level of $100,000 per quality-adjusted life-year. RESULTS OF SENSITIVITY ANALYSIS The 95% CI for the net economic return of the trial was $23.1 to $51.2 billion. LIMITATION No evaluation of indirect costs or outcomes beyond 2012. CONCLUSION The WHI E+P trial made high-value use of public funds with a substantial return on investment. These results can contribute to discussions about the role of public funding for large, prospective trials with high potential for public health effects. PRIMARY FUNDING SOURCE National Heart, Lung, and Blood Institute.
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141
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Low-dose paroxetine 7.5 mg for menopausal vasomotor symptoms: two randomized controlled trials. Menopause 2014; 20:1027-35. [PMID: 24045678 DOI: 10.1097/gme.0b013e3182a66aa7] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The efficacy and safety of low-dose paroxetine 7.5 mg for the treatment of menopausal vasomotor symptoms were evaluated in two multicenter, double-blind, placebo-controlled, phase 3 studies of 12 and 24 weeks' duration. METHODS Postmenopausal women were randomly assigned 1:1 to receive paroxetine 7.5 mg or placebo once daily. The four primary efficacy endpoints included mean changes in the frequency and severity of moderate to severe vasomotor symptoms on weeks 4 and 12; an additional endpoint was persistence of treatment benefit on week 24. RESULTS Five hundred ninety-one participants were randomly assigned to treatment with paroxetine 7.5 mg, and 593 participants were randomly assigned to treatment with placebo. All primary endpoints were met in the 24-week study; three of four primary endpoints were met in the 12-week study. In both studies, paroxetine 7.5 mg significantly reduced the mean weekly vasomotor symptom frequency compared with placebo on week 4 (P < 0.0001 for both studies) and week 12 (P = 0.0090, 12-wk study; P = 0.0001, 24-wk study). Mean weekly reduction in vasomotor symptom severity was significantly greater for paroxetine 7.5 mg than for placebo on week 4 (P = 0.0048) in the 12-week study and on week 4 (P = 0.0452) and week 12 (P = 0.0114) in the 24-week study. Persistence of treatment benefit was demonstrated in the 24-week study. Most treatment-emergent adverse events were mild or moderate in severity. No clinically significant changes in laboratory values or vital signs were noted, and no short-term discontinuation of symptoms followed treatment cessation. CONCLUSIONS Paroxetine 7.5 mg is well-tolerated, is effective in reducing the frequency and severity of menopausal vasomotor symptoms, and demonstrates persistence of treatment benefit through 24 weeks of treatment.
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Newton KM, Reed SD, Guthrie KA, Sherman KJ, Booth-LaForce C, Caan B, Sternfeld B, Carpenter JS, Learman LA, Freeman EW, Cohen LS, Joffe H, Anderson GL, Larson JC, Hunt JR, Ensrud KE, LaCroix AZ. Efficacy of yoga for vasomotor symptoms: a randomized controlled trial. Menopause 2014; 21:339-46. [PMID: 24045673 PMCID: PMC3871975 DOI: 10.1097/gme.0b013e31829e4baa] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aims to determine the efficacy of yoga in alleviating vasomotor symptoms (VMS) frequency and bother. METHODS This study was a three-by-two factorial, randomized controlled trial. Eligible women were randomized to yoga (n = 107), exercise (n = 106), or usual activity (n = 142), and were simultaneously randomized to a double-blind comparison of ω-3 fatty acid (n = 177) or placebo (n = 178) capsules. Yoga intervention consisted of 12 weekly 90-minute yoga classes with daily home practice. Primary outcomes were VMS frequency and bother assessed by daily diaries at baseline, 6 weeks, and 12 weeks. Secondary outcomes included insomnia symptoms (Insomnia Severity Index) at baseline and 12 weeks. RESULTS Among 249 randomized women, 237 (95%) completed 12-week assessments. The mean baseline VMS frequency was 7.4 per day (95% CI, 6.6 to 8.1) in the yoga group and 8.0 per day (95% CI, 7.3 to 8.7) in the usual activity group. Intent-to-treat analyses included all participants with response data (n = 237). There was no difference between intervention groups in the change in VMS frequency from baseline to 6 and 12 weeks (mean difference [yoga--usual activity] from baseline at 6 wk, -0.3 [95% CI, -1.1 to 0.5]; mean difference [yoga--usual activity] from baseline at 12 wk, -0.3 [95% CI, -1.2 to 0.6]; P = 0.119 across both time points). Results were similar for VMS bother. At week 12, yoga was associated with an improvement in insomnia symptoms (mean difference [yoga - usual activity] in the change in Insomnia Severity Index, 1.3 [95% CI, -2.5 to -0.1]; P = 0.007). CONCLUSIONS Among healthy women, 12 weeks of yoga class plus home practice, compared with usual activity, do not improve VMS frequency or bother but reduce insomnia symptoms.
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Affiliation(s)
| | - Susan D. Reed
- Departments of Obstetrics/Gynecology and Epidemiology, University of Washington School of Medicine, Seattle, WA
| | | | | | | | - Bette Caan
- Division of Research, Kaiser Permanent Medical Program of Northern California, Oakland, CA
| | - Barbara Sternfeld
- Division of Research, Kaiser Permanent Medical Program of Northern California, Oakland, CA
| | | | - Lee A. Learman
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN
| | - Ellen W. Freeman
- Department of Obstetrics/Gynecology, University of Pennsylvania, Philadelphia, PA
| | | | | | - Garnet L. Anderson
- Data Coordinating Center, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Joseph C. Larson
- Data Coordinating Center, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Julie R. Hunt
- Data Coordinating Center, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Kristine E. Ensrud
- Department of Medicine, VA Medical Center / Division of Epidemiology and Community Health University of Minnesota, Minneapolis, MN
| | - Andrea Z. LaCroix
- Data Coordinating Center, Fred Hutchinson Cancer Research Center, Seattle, WA
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Constantine G, Graham S, Koltun WD, Kingsberg SA. Assessment of Ospemifene or Lubricants on Clinical Signs of VVA. J Sex Med 2014; 11:1033-1041. [DOI: 10.1111/jsm.12428] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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144
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Bassuk SS, Manson JE. Menopausal hormone therapy and cardiovascular disease risk: utility of biomarkers and clinical factors for risk stratification. Clin Chem 2014; 60:68-77. [PMID: 24379312 DOI: 10.1373/clinchem.2013.202556] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Menopausal hormone therapy (HT) continues to have a clinical role in symptom management, but identifying women for whom benefits will outweigh the risks remains a challenge. Although hormone therapy (HT) is the most effective strategy for ameliorating vasomotor and other symptoms, randomized clinical trials show an unfavorable balance of benefits and risks for many women. However, closer examination of data from these trials suggests that it may be possible to classify women as better or worse candidates for HT by using individual risk stratification. CONTENT Data from 2 landmark trials-the Women's Health Initiative (WHI) and the Heart and Estrogen/progestin Replacement Study (HERS)-suggest an important role for clinical characteristics, serum biomarkers, genomic markers, and gene-environment interactions in developing a personalized approach to the prediction of risk for cardiovascular disease (CVD) events for women while on HT. The available data suggest several characteristics of women who are optimal candidates for HT use: younger age (<60 years), recent onset of menopause (<10 years), favorable lipid profile (LDL cholesterol <130 mg/dL or LDL/HDL cholesterol ratio <2.5), absence of metabolic syndrome, and absence of factor V Leiden genotype. The identification of other characteristics is an area of active investigation. In addition, women at high risk for venous thromboembolism should avoid systemic HT or choose a transdermal rather than oral delivery route. SUMMARY Personalized medicine-i.e., the use of the specific biological profile of an individual to guide the choice of treatment-is highly relevant for clinical decision-making regarding HT and offers promise for improved treatment efficacy and safety.
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Affiliation(s)
- Shari S Bassuk
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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146
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Effects of the kampo formula tokishakuyakusan on headaches and concomitant depression in middle-aged women. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:593560. [PMID: 24648849 PMCID: PMC3932270 DOI: 10.1155/2014/593560] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 12/27/2013] [Accepted: 12/27/2013] [Indexed: 11/27/2022]
Abstract
Objectives. To identify the correlates of headaches in middle-aged women and investigate the effects of Tokishakuyakusan (TJ-23), a formula of traditional Japanese herbal therapy Kampo, on headache and concomitant depression. Methods. We examined cross-sectionally the baseline records of 345 women aged 40–59 years who visited our menopause clinic. Among them, 37 women with headaches were treated with either hormone therapy (HT) or TJ-23; the data of these women were retrospectively analyzed to compare the effects of the treatment. Results. The women were classified into 4 groups on the basis of their headache frequency, and no significant intergroup differences were noted in the physical or lifestyle factors, except age. Multiple logistic regression analysis revealed that the significant contributors to the women's headaches were their age (adjusted OR 0.92 (95% CI 0.88–0.97)) and their depressive symptoms (adjusted OR 1.73 (95% CI 1.39–2.16)). Compared to women treated with HT, women treated with TJ-23 reported relief from headaches (65% versus 29%) and concomitant depression (60% versus 24%) more frequently. Improvement in the scores of headaches and depression correlated significantly with TJ-23 treatment. Conclusions. Headache in middle-aged women is significantly associated with depression; TJ-23 could be effective for treating both of these symptoms.
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147
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Blümel JE, Chedraui P, Barón G, Benítez Z, Flores D, Espinoza MT, Gomez G, González E, Hernández L, Lima S, Martino M, Montaño A, Monterrosa A, Mostajo D, Ojeda E, Onatra W, Robles C, Saavedra J, Sánchez H, Tserotas K, Vallejo MS, Vallejo C. A multicentric study regarding the use of hormone therapy during female mid-age (REDLINC VI). Climacteric 2014; 17:433-41. [PMID: 24443950 DOI: 10.3109/13697137.2014.882305] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Menopausal hormone therapy (HT) has shown benefits for women; however, associated drawbacks (i.e. risks, costs, fears) have currently determined its low use. OBJECTIVE To determine the prevalence of current HT use among mid-aged women and describe the characteristics of those who have never used, have abandoned or are currently using HT. In addition, reasons for not using HT were analyzed. METHOD This was a cross-sectional study that analyzed a total of 6731 otherwise healthy women (45-59 years old) of 15 cities in 11 Latin American countries. Participants were requested to fill out the Menopause Rating Scale (MRS) and a questionnaire containing sociodemographic data and items regarding the menopause and HT use. RESULTS The prevalence of current HT use was 12.5%. Oral HT (43.7%) was the most frequently used type of HT, followed by transdermal types (17.7%). The main factors related to the current use of HT included: positive perceptions regarding HT (odds ratio (OR) 11.53, 95% confidence interval (CI) 9.41-14.13), being postmenopausal (OR 3.47, 95% CI 2.75-4.36) and having a better socioeconomic level. A total of 48.8% of surveyed women had used HT in the past, but abandoned it due to symptom improvement or being unconcerned; fear of cancer or any other secondary effects were also reported but in less than 10%. Among women who had never used HT, 28% reported the lack of medical prescription as the main reason, followed by the absence of symptoms (27.8%). Among those reporting lack of prescription as the main reason for not using HT, 30.6% currently had severe menopausal symptoms (total MRS score > 16); 19.5% of women were using alternative 'natural' therapies, with 35.1% of them displaying severe menopausal symptoms as compared to a 22.5% observed among current HT users. CONCLUSION The use of HT has not regained the rates observed a decade ago. Positive perceptions regarding HT were related to a higher use. Lack of medical prescription was the main reason for not using HT among non-users, many of whom were currently displaying severe menopausal symptoms.
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148
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Stevens VL, Jacobs EJ, Patel AV, Sun J, Gapstur SM, McCullough ML. Body weight in early adulthood, adult weight gain, and risk of endometrial cancer in women not using postmenopausal hormones. Cancer Causes Control 2014; 25:321-8. [DOI: 10.1007/s10552-013-0333-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 12/20/2013] [Indexed: 01/01/2023]
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149
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Munsell MF, Sprague BL, Berry DA, Chisholm G, Trentham-Dietz A. Body mass index and breast cancer risk according to postmenopausal estrogen-progestin use and hormone receptor status. Epidemiol Rev 2014; 36:114-36. [PMID: 24375928 PMCID: PMC3873844 DOI: 10.1093/epirev/mxt010] [Citation(s) in RCA: 242] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2013] [Indexed: 12/20/2022] Open
Abstract
To assess the joint relationships among body mass index, menopausal status, and breast cancer according to breast cancer subtype and estrogen-progestin medication use, we conducted a meta-analysis of 89 epidemiologic reports published in English during 1980-2012 identified through a systematic search of bibliographic databases. Pooled analysis yielded a summary risk ratio of 0.78 (95% confidence interval (CI): 0.67, 0.92) for hormone receptor-positive premenopausal breast cancer associated with obesity (body mass index (weight (kg)/height (m)(2)) ≥30 compared with <25). Obesity was associated with a summary risk ratio of 1.39 (95% CI: 1.14, 1.70) for receptor-positive postmenopausal breast cancer. For receptor-negative breast cancer, the summary risk ratios of 1.06 (95% CI: 0.70, 1.60) and 0.98 (95% CI: 0.78, 1.22) associated with obesity were null for both premenopausal and postmenopausal women, respectively. Elevated postmenopausal breast cancer risk ratios associated with obesity were limited to women who never took estrogen-progestin therapy, with risk ratios of 1.42 (95% CI: 1.30, 1.55) among never users and 1.18 (95% CI: 0.98, 1.42) among users; too few studies were available to examine this relationship according to receptor subtype. Future research is needed to confirm whether obesity is unrelated to receptor-negative breast cancer in populations of postmenopausal women with low prevalence of hormone medication use.
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Affiliation(s)
| | | | | | | | - Amy Trentham-Dietz
- Correspondence to Dr. Amy Trentham-Dietz, University of Wisconsin, 610 Walnut Street, WARF Room 307, Madison, WI 53726 (e-mail: )
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Rudolph A, Hein R, Lindström S, Beckmann L, Behrens S, Liu J, Aschard H, Bolla MK, Wang J, Truong T, Cordina-Duverger E, Menegaux F, Brüning T, Harth V, Severi G, Baglietto L, Southey M, Chanock SJ, Lissowska J, Figueroa JD, Eriksson M, Humpreys K, Darabi H, Olson JE, Stevens KN, Vachon CM, Knight JA, Glendon G, Mulligan AM, Ashworth A, Orr N, Schoemaker M, Webb PM, Guénel P, Brauch H, Giles G, García-Closas M, Czene K, Chenevix-Trench G, Couch FJ, Andrulis IL, Swerdlow A, Hunter DJ, Flesch-Janys D, Easton DF, Hall P, Nevanlinna H, Kraft P, Chang-Claude J. Genetic modifiers of menopausal hormone replacement therapy and breast cancer risk: a genome-wide interaction study. Endocr Relat Cancer 2013; 20:875-87. [PMID: 24080446 PMCID: PMC3863710 DOI: 10.1530/erc-13-0349] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Women using menopausal hormone therapy (MHT) are at increased risk of developing breast cancer (BC). To detect genetic modifiers of the association between current use of MHT and BC risk, we conducted a meta-analysis of four genome-wide case-only studies followed by replication in 11 case-control studies. We used a case-only design to assess interactions between single-nucleotide polymorphisms (SNPs) and current MHT use on risk of overall and lobular BC. The discovery stage included 2920 cases (541 lobular) from four genome-wide association studies. The top 1391 SNPs showing P values for interaction (Pint) <3.0 × 10(-3) were selected for replication using pooled case-control data from 11 studies of the Breast Cancer Association Consortium, including 7689 cases (676 lobular) and 9266 controls. Fixed-effects meta-analysis was used to derive combined Pint. No SNP reached genome-wide significance in either the discovery or combined stage. We observed effect modification of current MHT use on overall BC risk by two SNPs on chr13 near POMP (combined Pint≤8.9 × 10(-6)), two SNPs in SLC25A21 (combined Pint≤4.8 × 10(-5)), and three SNPs in PLCG2 (combined Pint≤4.5 × 10(-5)). The association between lobular BC risk was potentially modified by one SNP in TMEFF2 (combined Pint≤2.7 × 10(-5)), one SNP in CD80 (combined Pint≤8.2 × 10(-6)), three SNPs on chr17 near TMEM132E (combined Pint≤2.2×10(-6)), and two SNPs on chr18 near SLC25A52 (combined Pint≤4.6 × 10(-5)). In conclusion, polymorphisms in genes related to solute transportation in mitochondria, transmembrane signaling, and immune cell activation are potentially modifying BC risk associated with current use of MHT. These findings warrant replication in independent studies.
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Affiliation(s)
- Anja Rudolph
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rebecca Hein
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- PMV Research Group at the Department of Child and Adolescent Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Sara Lindström
- Program in Molecular and Genetic Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Lars Beckmann
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Foundation for Quality and Efficiency in Health Care (IQWIG), Cologne, Germany
| | - Sabine Behrens
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jianjun Liu
- Human Genetics, Genome Institute of Singapore, Singapore, Singapore
| | - Hugues Aschard
- Program in Molecular and Genetic Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Manjeet K. Bolla
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jean Wang
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Thérèse Truong
- INSERM (National Institute of Health and Medical Research), CESP (Center for Research in Epidemiology and Population Health), U1018, Environmental Epidemiology of Cancer, Villejuif, France
- Unité Mixte de Recherche Scientifique (UMRS) 1018, University Paris-Sud, Villejuif, France
| | - Emilie Cordina-Duverger
- INSERM (National Institute of Health and Medical Research), CESP (Center for Research in Epidemiology and Population Health), U1018, Environmental Epidemiology of Cancer, Villejuif, France
- Unité Mixte de Recherche Scientifique (UMRS) 1018, University Paris-Sud, Villejuif, France
| | - Florence Menegaux
- INSERM (National Institute of Health and Medical Research), CESP (Center for Research in Epidemiology and Population Health), U1018, Environmental Epidemiology of Cancer, Villejuif, France
- Unité Mixte de Recherche Scientifique (UMRS) 1018, University Paris-Sud, Villejuif, France
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany
| | - Volker Harth
- Institute for Occupational Medicine and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - The GENICA Network
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany
- Institute for Occupational Medicine and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Germany
- Department of Internal Medicine, Evangelische Kliniken Bonn gGmbH, Johanniter Krankenhaus, Bonn, Germany
- Institute of Pathology, University of Bonn, Germany
- Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, University of Tübingen, Stuttgart, Germany
| | - Gianluca Severi
- Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Australia
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, The University of Melbourne, Australia
| | - Laura Baglietto
- Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Australia
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, The University of Melbourne, Australia
| | - Melissa Southey
- Department of Pathology, The University of Melbourne, Australia
| | - Stephen J. Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, United States of America
| | - Jolanta Lissowska
- Department of Cancer Epidemiology and Prevention, M. Sklodowska-Curie Memorial Cancer Center & Institute of Oncology, Warsaw, Poland
| | - Jonine D. Figueroa
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, United States of America
| | - Mikael Eriksson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Keith Humpreys
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Hatef Darabi
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Janet E. Olson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Kristen N. Stevens
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Celine M. Vachon
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Julia A. Knight
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Gord Glendon
- Ontario Cancer Genetics Network, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Anna Marie Mulligan
- Laboratory Medicine Program, University Health Network; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Alan Ashworth
- Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK
- Division of Breast Cancer Research, The Institute of Cancer Research, Sutton, Surrey, UK
| | - Nicholas Orr
- Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK
- Division of Breast Cancer Research, The Institute of Cancer Research, Sutton, Surrey, UK
| | - Minouk Schoemaker
- Breakthrough Breast Cancer Research Centre, The Institute of Cancer Research, London, UK
- Division of Breast Cancer Research, The Institute of Cancer Research, Sutton, Surrey, UK
| | - Penny M. Webb
- Queensland Institute of Medical Research, Brisbane, Australia
| | | | - AOCS Management Group
- Queensland Institute of Medical Research, Brisbane, Australia
- Peter MacCallum Cancer Center, Melbourne, Australia
| | - Pascal Guénel
- INSERM (National Institute of Health and Medical Research), CESP (Center for Research in Epidemiology and Population Health), U1018, Environmental Epidemiology of Cancer, Villejuif, France
- Unité Mixte de Recherche Scientifique (UMRS) 1018, University Paris-Sud, Villejuif, France
| | - Hiltrud Brauch
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, University of Tübingen, Stuttgart, Germany
| | - Graham Giles
- Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Australia
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, The University of Melbourne, Australia
| | - Montserrat García-Closas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, United States of America
- Sections of Epidemiology and Genetics, Institute of Cancer Research and Breakthrough Breast Cancer Research Centre, London, United Kingdom
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - Fergus J. Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Irene L. Andrulis
- Ontario Cancer Genetics Network, Fred A. Litwin Center for Cancer Genetics, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Anthony Swerdlow
- Division of Breast Cancer Research, The Institute of Cancer Research, Sutton, Surrey, UK
- Division of Genetics and Epidemiology, The Institute of Cancer Research, Sutton, Surrey, UK
| | - David J. Hunter
- Program in Molecular and Genetic Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Dieter Flesch-Janys
- Department of Cancer Epidemiology/Clinical Cancer Registry and Institute for Medical Biometrics and Epidemiology, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Douglas F. Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Heli Nevanlinna
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Peter Kraft
- Program in Molecular and Genetic Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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