1
|
Zanetti R, Ponti A, Rosso S, Ricceri F, Pitarella S, Segnan N. The Beginning of a Decline in Breast Cancer Incidence in Italy? TUMORI JOURNAL 2018; 94:293-6. [DOI: 10.1177/030089160809400301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The incidence of invasive breast cancer in Turin, Italy, showed a statistically significant decrease during 1999–2003 overall (estimated annual percent change -2.6; 95% CL -8.52; -0.78) and in women aged over 50, similar to the recently documented trend in American data. This represents the first demonstration of a decline in breast cancer incidence in the early years of this decade outside the United States. In our population, the drop in the usage of hormone replacement therapy which occurred after 2002 is unlikely to be at the origin of this declining incidence trend, which is largely explained by a screening effect. This observation may be relevant to other geographical areas where organized or spontaneous screening reached a plateau after an increase in the preceding years.
Collapse
Affiliation(s)
| | - Antonio Ponti
- Unità di Valutazione dello Screening Mammografico, CPO, Turin, Italy
| | | | | | - Sabina Pitarella
- Unità di Valutazione dello Screening Mammografico, CPO, Turin, Italy
| | - Nereo Segnan
- Unità di Epidemiologia dei Tumori, Centro per l'Epidemiologia e la Prevenzione Oncologica, CPO, Turin, Italy
| |
Collapse
|
2
|
Crocetti E, Buzzoni C, Falcini F, Cortesi L, De Lisi V, Ferretti S, Tumino R, Russo A, Paci E. Disentangling the roles of mammographic screening and HRT in recent breast cancer incidence trends in italy by analyses based on calendar time and time since screening activation. Breast J 2010; 16:350-5. [PMID: 20443789 DOI: 10.1111/j.1524-4741.2010.00928.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of the study was to evaluate the roles of screening activation and hormone replacement therapy discontinuation on the recent declining breast cancer incidence trends in Italy. We analyzed 41,358 invasive female breast cancers incident during 1991-2004 in six Italian population-based cancer registries. Overall and age-specific incidence trends were evaluated using Joinpoint analysis. In addition to calendar years, data were analyzed on a years-since-screening-activation basis. Annual percentage change of standardized rates was computed. There were statistically significant increasing trends for women 40-44 and 45-49 years that did not change after screening activation. On the contrary, for women 50-69 years old and for those 70+ years, the increasing trends flattened around 2 years after screening activation. The prevalence of hormone replacement therapy use in Italy is and was rather low. In conclusion, the recent tendency toward stabilization observed in Italy for female breast cancer incidence rates in women aged 50 years or more follows the introduction of mammographic screening.
Collapse
Affiliation(s)
- Emanuele Crocetti
- Registro Tumori Toscano, Unità di Epidemiologia Clinica e Descrittiva, ISPO, Firenze, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
3
|
|
4
|
Parazzini F. Trends of determinants of hormone therapy use in Italian women attending menopause clinics, 1997-2003. Menopause 2008; 15:164-70. [PMID: 17581495 DOI: 10.1097/gme.0b013e318057782b] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Analysis of patterns of hormone therapy (HT) use among postmenopausal Italian women, before and after publication of results from the Heart and Estrogen/progestin Replacement Study and the Women's Health Initiative. DESIGN This was a cross-sectional study conducted between 1997 and 2003 on the characteristics of women around the age of menopause. The study population consisted of 106,784 women (mean age 53 y) attending menopause clinics in Italy. Postmenopausal women were defined as women with surgical menopause (ie, bilateral oophorectomy with or without hysterectomy), women older than 55 years who underwent hysterectomy without bilateral oophorectomy, and women whose menstrual cycles had stopped more than 1 year before their interview. RESULTS A total of 15,657 women (14.7%) reported ever using HT. The prevalence of HT prescription was 17.6% among women observed in 1997-1998, 14.9% in 1999, 12.2% in 2000, 12.1% in 2001, and 11.4% in 2002-2003. HT use was related to age at menopause and level of education in all the periods considered and was more frequent in women reporting surgical menopause. The odds ratio of HT prescription tended to decrease in women with surgical menopause, with slight fluctuations in the intermediate years. Ever users of oral contraceptives and nulliparae were more frequently HT users. CONCLUSIONS In our population the percentage of current HT users dropped from 17.6% in 1997-1998 to 11.4% in 2002-2003. However, the determinants of use were largely unchanged during the study period: women with higher education, nulliparae, and smokers reported more frequent HT use.
Collapse
|
5
|
Ponti A, Rosso S, Zanetti R, Ricceri F, Tomatis M, Segnan N. Re: Breast Cancer Incidence, 1980-2006: Combined Roles of Menopausal Hormone Therapy, Screening Mammography, and Estrogen Receptor Status. J Natl Cancer Inst 2007; 99:1817-8; author reply 1819. [DOI: 10.1093/jnci/djm225] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
|
6
|
Corrao G, Zambon A, Nicotra F, Fornari C, La Vecchia C, Mezzanzanica M, Nappi RE, Merlino L, Cesana G. Persistence with oral and transdermal hormone replacement therapy and hospitalisation for cardiovascular outcomes. Maturitas 2007; 57:315-24. [PMID: 17485182 DOI: 10.1016/j.maturitas.2007.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Revised: 03/08/2007] [Accepted: 03/12/2007] [Indexed: 11/16/2022]
Abstract
BACKGROUND The effect of persistence with transdermal and oral administrations of hormone replacement therapy (HRT) on the risk of hospitalisation for cardiovascular disease, and the role of income as potential confounder, were explored in a large population-based cohort study. METHODS Seventy-eight thousand eight hundred and seventy-five women resident in the Italian Lombardy Region aged 45-65 years who received at least one HRT prescription during 1998-2000 were followed until December 2003. The 828 cohort members who experienced at least one hospitalisation for a circulatory system disease were identified from the Regional hospital discharge database. The Regional prescription drug database was used to assess cumulative persistence with hormone treatment during follow-up. Data on individual taxable income was also obtained for women resident in the city of Milan. A proportional hazards model was fitted to estimate the association between cumulative time-dependent persistence with HRT and cardiovascular risk. RESULTS Compared with women who took HRT for less than 6 months, those exposed for more than 3 years to HRT as a whole, and to transdermal and oral HRT, respectively, showed hazard ratios of 0.65 (95% confidence interval: 0.45, 0.92), 0.53 (0.34, 0.82), and 1.15 (0.47, 2.79). CVD reducing potential of HRT disappeared when estimates were adjusted for income being hazard ratio associated with long-term use 0.94 (0.52, 1.71). CONCLUSIONS Evidence that CVD risk associated with long-term hormone treatment varies according to the route of HRT administration, and that economic position confounds the effect of HRT on the risk of cardiovascular hospitalisation, is provided by the current study.
Collapse
Affiliation(s)
- Giovanni Corrao
- Department of Statistics, Unit of Biostatistics, University of Milan-Bicocca, Milan, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Biglia N, Ujcic E, Kubatzki F, Sgandurra P, Robba C, Ponzone R, Sismondi P. Personal use of hormone therapy by postmenopausal women doctors and male doctors’ wives in Italy after the publication of WHI trial. Maturitas 2006; 54:181-92. [PMID: 16330170 DOI: 10.1016/j.maturitas.2005.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2005] [Revised: 10/12/2005] [Accepted: 10/17/2005] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the prevalence of hormone replacement therapy (HT) use by postmenopausal women doctors and doctors' wives in Italy and to explore the relationship between their personal characteristics and HT use. DESIGN A total of 500 women doctors and 500 men doctors answering on behalf of their female partners were interviewed by a specialised company in the first months of 2003. Questions were meant to explore medical, behavioural and professional characteristics, personal use of HT, reasons for or against HT use and side effects of HT. The distribution of doctors' specialisation (general practitioners (GPs), gynaecologists, medical oncologists) in the sample interviewed was the same as that of the Italian medical community. RESULTS Overall, 37% of women doctors and 39% of doctors' wives had ever used HT after menopause, of which 64 and 58%, respectively, were current users. The median duration of HT in the past users was 2.7 years for women doctors and 3.7 for doctors' wives. There were wide differences of HT use according to the type of specialisation: gynaecologists were more willing to use HT (56-59%) than GPs (30-31%) or medical oncologists (16-30%). Vasomotor symptoms (68-69%), followed by the prevention of osteoporosis (28-39%), were the main reasons for commencing HT. The main reasons not to take or to stop HT were the absence or resolution of menopausal symptoms. Only 8% of women doctors and 4% doctors' wives stopped HT after the publication of the WHI data. CONCLUSIONS In Italy, women doctors/doctors' wives personally use HT much more than postmenopausal general population.
Collapse
Affiliation(s)
- Nicoletta Biglia
- Gynaecological Oncology Department, University of Turin, Mauriziano Umberto I Hospital, Largo Turati 62, 10128 Turin, Italy.
| | | | | | | | | | | | | |
Collapse
|
8
|
van Duijnhoven FJB, van Gils CH, Bezemer ID, Peeters PHM, van der Schouw YT, Grobbee DE. Use of hormones in the menopausal transition period in the Netherlands between 1993 and 1997. Maturitas 2006; 53:462-75. [PMID: 16198516 DOI: 10.1016/j.maturitas.2005.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2005] [Revised: 08/04/2005] [Accepted: 08/09/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To describe the patterns and to assess the indicators of hormone use during the menopausal transition period in a Dutch population. METHODS Between 1993 and 1997, 17,357 women aged 49-70 years participated in the Prospect-EPIC (European Prospective Investigation into Cancer and Nutrition) cohort and filled out an extensive questionnaire, which included information about hormone use during menopausal transition and other medical and lifestyle characteristics. Patterns of hormone use were described and various characteristics were evaluated as indicators of current hormone use by logistic regression. RESULTS Overall, 13% of women were current hormone users, which was highest in the 49-54 age group (19%). Hysterectomized women and older non-hysterectomized women mainly used unopposed estrogen therapy (ET), whereas younger non-hysterectomized women mainly used oral contraceptives or combined estrogen+progestogen therapy. Of all ever users, 61% used hormones for more than 1 year and 28% for more than 5 years. The most important indicators of hormone use for women without a surgical menopause were age, alcohol use, smoking, parity, ever use of oral contraceptives and family history of breast cancer. For women with a surgical menopause age, parity, ever use of oral contraceptives, diastolic blood pressure and the number of removed ovaries were the most relevant indicators. CONCLUSIONS The frequency of hormone use during menopausal transition in the Netherlands is low compared to other western countries, but the duration of use is quite long. Hormone use seems to be largely determined by factors that are known to affect endogenous estrogen levels.
Collapse
Affiliation(s)
- Fränzel J B van Duijnhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | | | | | |
Collapse
|
9
|
Bermejo MJ, Pérez IR. Physicians and the prescription of hormone replacement therapy in Spain. Health Policy 2005; 73:58-65. [PMID: 15911057 DOI: 10.1016/j.healthpol.2004.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2004] [Accepted: 10/06/2004] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this study was to determine the frequency of hormone replacement therapy (HRT) prescription and identify women's sociodemographic and climacteric factors, as well as variables related to healthcare, associated with the treatment's prescription in women aged 45-65 years in the reference population of a primary healthcare centre in the city of Granada (Spain). METHODS A descriptive cross-sectional telephone survey was conducted in July 2002 with women aged 45-65 years from the reference population of a primary healthcare centre. The information was gathered using a semi-structured questionnaire specifically developed to gather information on the prescription of HRT. RESULTS 22.3% of the sample had ever been prescribed with HRT. Regarding compliance with the treatment, 44.2% of the women prescribed with this therapy took it partially, and 8.1% did not begin with the treatment. The variables independently associated with HRT prescription were having the menopause (OR=2.81; IC 95%: 1.08-7.28), having psychological symptoms (OR=2.77; IC 95%: 1.19-6.46), going to see the gynaecologist (OR=4.41; IC 95%: 1.87-10.36), and the fact that the doctor worked in the private healthcare sector (OR=3.55; IC 95%: 0.92-13.65). CONCLUSIONS The frequency of HRT prescription in Spain is high, as well as the non-compliance rate. Reaching the menopause and going to the gynaecologist are determinant in HRT prescription. It would be desirable to use similar methodological approaches in studies of this controversial therapy, in order to obtain consensus on the real impact on the female population, particularly in view of the results of the latest clinical trials.
Collapse
Affiliation(s)
- María José Bermejo
- Department of Preventive Medicine, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | |
Collapse
|
10
|
Manzoli L, Di Giovanni P, Del Duca L, De Aloysio D, Festi D, Capodicasa S, Monastra G, Romano F, Staniscia T. Use of hormone replacement therapy in Italian women aged 50-70 years. Maturitas 2005; 49:241-51. [PMID: 15488353 DOI: 10.1016/j.maturitas.2004.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2003] [Revised: 01/25/2004] [Accepted: 02/17/2004] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The aim of the present cross-sectional analysis was to describe patterns and determinants of use of hormone replacement therapy (HRT) in a large sample of women attending mammographic screening. METHODS Between 1999 and 2001, 8533 women aged 50-70 years were recruited by 11 screening centres, and structured interviews were made collecting information on socio-demographic characteristics, lifestyle habits, medical and reproductive history (overall response rate 87%). RESULTS Current HRT use was reported by 6.9% of women (n=585), the average duration of use being 3.5 years; 13.2% were ever HRT users. Binomial and multinomial logistic regression (MLR) analyses showed that younger age, higher educational level, past mammographic examination and history of bilateral oophorectomy were the major predictors of current and ever HRT use. Current use was also more frequently reported by women who were thinner, nulliparae, had had induced menopause, had a later onset of menopause, with history of oral contraceptive use and hysterectomy without bilateral oophorectomy. By contrast, those who were diabetics or had positive history of cardiovascular disease were less likely to be current HRT users. No differences were found in HRT use according to marital status, type of occupation, menopausal status, smoking, history of breast cancer, hypercholesterolemia, hypertension and phlebitis. CONCLUSIONS Our results support previous findings indicating that HRT use in Italian women is uncommon and of short duration. Current HRT users were less likely than non-users to report several characteristics associated with higher mortality and morbidity, in accordance with the healthy-user phenomenon described in other countries.
Collapse
Affiliation(s)
- Lamberto Manzoli
- Section of Epidemiology and Public Health, University G. d'Annunzio of Chieti, Via dei Vestini 5, Chieti 66013, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Altieri A, Gallus S, Franceschi S, Fernandez E, Talamini R, La Vecchia C. Hormone replacement therapy and risk of lymphomas and myelomas. Eur J Cancer Prev 2004; 13:349-51. [PMID: 15554564 DOI: 10.1097/01.cej.0000136573.16740.9c] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The relation between post-menopausal hormone replacement therapy (HRT) and lymphoid neoplasms was analysed using data from a case-control study conducted in northern Italy between 1983 and 1992. Cases included 26 incident, histologically confirmed, post-menopausal female patients of Hodgkin's Disease (HD), 145 non-Hodgkin's lymphomas (NHL) and 65 multiple myelomas (MM), between 45 and 79 years of age. The control group comprised 361 women (age range 45-79 years) admitted to the same network of hospitals for acute, non-neoplastic conditions. The multivariate odds ratio (OR) for ever HRT users was 0.7 [95% confidence interval (CI) 0.2-2.8] for HD, 0.7 (95% CI 0.3-1.4) for NHL, and 0.2 (95% CI 0.1-1.0) for MM. No clear pattern of association was found for duration or recently of use. Despite the relatively small number of cases, due to the rarity of the disease, and the low frequency of HRT use in this population, these findings provide additional information for any global risk-benefit assessment of HRT use.
Collapse
Affiliation(s)
- A Altieri
- Istituto di Ricerche Farmacologiche Mario Negri, via Eritrea 62, 20157 Milano, Italy.
| | | | | | | | | | | |
Collapse
|
12
|
Burusanont M, Hadsall RS. Factors associated with intention to use hormone replacement therapy among Thai middle-aged women. Maturitas 2004; 47:219-27. [PMID: 15036492 DOI: 10.1016/s0378-5122(03)00281-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2002] [Revised: 01/24/2003] [Accepted: 02/01/2003] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To examine the differences among those who express their intentions to use hormone replacement therapy (intenders), those who express their intentions not to use hormone replacement therapy (non-intenders), and those who are undecided, and to examine the factors associated with hormone replacement therapy (HRT) intention among Thai middle-aged women. METHODS A total of 420 women aged 40-59 years, recruited from one hospital in Bangkok were asked to complete a self-administered questionnaire. RESULTS Compared to intenders and non-intenders, the undecided were significantly less knowledgeable about menopause and HRT, and perceived the highest level of decisional uncertainty. Being inadequately informed was the most important factor that distinguished the undecided from intenders and non-intenders. When looking at intenders and non-intenders, no significant differences in perceived information inadequacy, level of knowledge, and perceived risks of HRT were found. However, it was found that intenders perceived higher benefit over risk of HRT (OR = 1.05, 95% CI = 1.02, 1.07), held more negative beliefs towards menopause (OR = 1.61, 95% CI = 1.03, 2.53), and were approximately two times more likely to have ever used oral contraceptives (OR = 1.99, 95% CI = 1.13, 3.47) than non-intenders. CONCLUSION The findings reveal the importance of being informed about menopause and HRT in making decision about HRT use. Changes in knowledge, and beliefs are promising avenues to study to see how these impacts HRT use.
Collapse
Affiliation(s)
- Montarat Burusanont
- Faculty of Pharmacy, Mahidol University, 447 Sri Ayudhya Road, Ratchathevi, Bangkok 10400, Thailand.
| | | |
Collapse
|
13
|
Biglia N, Cozzarella M, Ponzone R, Marenco D, Maggiorotto F, Fuso L, Sismondi P. Personal use of HRT by postmenopausal women doctors and doctors' wives in the north of Italy. Gynecol Endocrinol 2004; 18:165-74. [PMID: 15255286 DOI: 10.1080/09513590310001653026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
This study aimed to describe the prevalence of hormone replacement therapy (HRT) use by women doctors and doctors' wives in northern Italy, to explore the relationship between their personal characteristics and HRT use, and to gather information about the use of alternative remedies. A questionnaire was mailed to all physicians born between 1935 and 1955 included in the database of the Medical Register of Turin County (Northern Italy). The questions were meant to explore medical, behavioral, and professional characteristics; personal use of HRT; reasons for and against HRT use; side effects and use of other therapies. 56.5% of postmenopausal women who completed the questionnaire had used HRTand 68.3% of them were current users. The median duration of HRT use was 3.7 years. Only 18.5% of the women had used HRT for 5 years or more; in this case, HRT was started significantly earlier than in the other groups. More than 50% had taken oral HRT, while 39% had used patches; estrogens only had been taken by 21.9%. HRT users had a significantly lower basal body mass index and more vasomotor and dystrophic symptoms at menopause onset compared with non-HRT users. More women on HRT were in good physical health and had an active sex life. Previous breast cancer and family history of cardiovascular diseases were inversely associated with HRT use. The main reason for not taking HRT or stopping it was fear of breast cancer (43.7% and 34.8%, respectively); irregular bleeding and weight gain were also frequently reported as a reason for HRT (30% and 22%). Overall, 22% of women had used alternative drugs to alleviate menopausal symptoms or prevent menopause-related diseases, mainly tibolone (21% among never HRT users and 2% among HRT users; p = 0.015) and phytoestrogens. The prevalence and duration of use of HRT by Italian physicians is consistent with the available data from other Western countries, and is much higher than in the general population. This is in contrast with the very low prevalence of use in the general population and may lead, in the near future, to a larger use of HRT in Italy.
Collapse
Affiliation(s)
- Nicoletta Biglia
- Gynecological Oncology Department, University of Turin, Mauriziano Umberto I Hospital, Turin, Italy
| | | | | | | | | | | | | |
Collapse
|
14
|
Rachoń D, Zdrojewski T, Suchecka-Rachoń K, Szpakowski P, Bandosz P, Manikowski A, Wyrzykowski B. Knowledge and use of hormone replacement therapy among Polish women: estimates from a nationally representative study—HORTPOL 2002. Maturitas 2004; 47:31-7. [PMID: 14706763 DOI: 10.1016/s0378-5122(03)00222-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To evaluate the knowledge about hormone replacement therapy (HRT) and the prevalence of its current use in Polish female population. METHODS Cross-sectional survey on a representative sample of 1544 women between 18 and 87 years of age. RESULTS Almost half of the Polish women have heard of HRT. Depending on the education level, 26-38% of women knew that HRT alleviates the physical and psychological symptoms of menopause and 18-32% knew that HRT reduces the risk of developing osteoporosis. Forty-three percent of all the women with a higher level of education were aware that HRT increases the risk of breast and uterine cancer. The prevalence of current HRT use among women aged 45-64 was 12%. Women who had only basic education were less likely to use HRT than those with a medium and higher education level. Lack of information about HRT was the main cause of not using it. Forty-four percent of the perimenopausal women (age range 45-54 years) have never heard of HRT and 36% were never told by their healthcare providers that they could use it. Nineteen percent of perimenopausal women were not using HRT because they were afraid of the HRT related risks. Sixty-four percent of women who were using HRT were prescribed oral HRT preparations. CONCLUSIONS A fairly small proportion of Polish women currently uses HRT, largely because most remain poorly informed about the therapy.
Collapse
Affiliation(s)
- Dominik Rachoń
- Department of Immunology of the Medical University of Gdańsk, ul. Debinki 1, 80-210 Gdańsk, Poland.
| | | | | | | | | | | | | |
Collapse
|
15
|
|
16
|
Lambert LJ, Straton JAY, Knuiman MW, Bartholomew HC. Health status of users of hormone replacement therapy by hysterectomy status in Western Australia. J Epidemiol Community Health 2003; 57:294-300. [PMID: 12646547 PMCID: PMC1732422 DOI: 10.1136/jech.57.4.294] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
STUDY OBJECTIVES To compare the demographic, behavioural, and biological correlates of use of hormone replacement therapy (HRT) in women with an intact uterus and women who have undergone hysterectomy. DESIGN Cross sectional analysis of data from the Busselton Health Study and the 1994 Healthway-National Heart Foundation Risk Factor Survey. SETTING Busselton and Perth, Western Australia, 1994. PARTICIPANTS 2540 women aged 35-79 years. MAIN OUTCOME MEASURES Demographic, behavioural, and biological correlates of use of HRT by hysterectomy status. RESULTS In women with an intact uterus, after adjustment for age and place of residence, current use of HRT was significantly associated with having a professional level of occupation, ever use of alcohol, having a history of smoking, and a lower body mass index. Current users of HRT had significantly lower levels of total cholesterol and higher levels of triglycerides than non-users. In women who had undergone hysterectomy, the only non-biological characteristic associated with use of HRT was having a history of smoking. Current users of HRT had lower levels of systolic blood pressure, lower levels of LDL cholesterol, higher levels of HDL cholesterol, and higher levels of triglycerides. The association between use of HRT and participation in exercise, level of systolic blood pressure, level of HDL cholesterol, and total/HDL cholesterol ratio varied significantly by hysterectomy status. After adjustment for age and place of residence, the mean levels of systolic and diastolic blood pressure, body mass index, waist/hip ratio, LDL cholesterol, and total/HDL cholesterol ratio were highest in women who had undergone hysterectomy and were not using HRT. CONCLUSIONS Demographic/behavioural and biological correlates of use of HRT varied depending on hysterectomy status. Demographic and behavioural characteristics were more important as selection factors for use of HRT in women with an intact uterus than in women who had undergone hysterectomy. Women who had undergone hysterectomy and were not using HRT had a significantly worse profile for CHD than did women with an intact uterus. These results indicate that any bias in estimates of the protective effect of HRT on risk of CHD in observational studies is likely to depend on the prevalence of hysterectomy within the study population. Hysterectomy status needs to be taken into account in any studies that investigate the effect of HRT on risk of CHD.
Collapse
Affiliation(s)
- L J Lambert
- School of Population Health, University of Western Australia, Crawley WA 6009, Australia
| | | | | | | |
Collapse
|
17
|
Mueller JE, Döring A, Heier M, Löwel H. Prevalence and determinants of hormone replacement therapy in German women 1984-1995. Maturitas 2002; 43:95-104. [PMID: 12385857 DOI: 10.1016/s0378-5122(02)00185-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe trends in prevalence and determinants of hormone replacement therapy (HRT) in German women. METHODS Three representative samples of women in Augsburg, Germany were examined in the MONICA surveys in 1984/85 (45-64 years; N=1013), 1989/90 and 1994/95 (both 45-74 years; N=1496 and 1475) by interview and anthropometry, and all drugs taken during the previous week were documented. The prevalence of HRT use was calculated by survey, age group and HRT type, and various characteristics were evaluated as determinants for any systemic HRT use by logistic regression. RESULTS The prevalence of HRT use in women aged 45-64 years in 1984/85, 1989/90 and 1994/95 was 3, 9% (age 45-74, 6%) and 23% (17%), respectively. In 1994/1995, positive determinants of HRT use were daily consumption of salad and vegetables, having quit smoking (vs. current smoking), regular exercise, ever having taken oral contraceptives, body mass index <25 kg/m(2) and age, and negative determinants were not drinking alcohol and education for <9 years (all P-value <0.10 in multivariate model). After multiple adjustment, HRT users were five times more likely to have participated in cancer screening and to have visited a gynaecologist >or=5 times during the previous year, and were less likely not to have seen a general practitioner or gynaecologist (all P-values <0.001). CONCLUSION HRT use increased substantially in Germany between 1984 and 1995. Women with characteristics associated with lower morbidity and mortality were more likely to use HRT, which agrees with the healthy-user phenomenon described in other countries.
Collapse
Affiliation(s)
- Judith E Mueller
- Institute of Epidemiology, GSF-National Research Centre for Environment and Health, Postfach 1129, D-85758, Neuherberg, Germany.
| | | | | | | |
Collapse
|
18
|
Blümel JE, Castelo-Branco C, Riquelme R, Araya H, Jaramillo P, Tacla X, Colodrón M, Lavín P. Use of hormone replacement therapy among Chilean women: a comparison between socioeconomic levels. Menopause 2002; 9:377-80. [PMID: 12218727 DOI: 10.1097/00042192-200209000-00011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the use of hormone replacement therapy (HRT) among Chilean women according to their socioeconomic level. METHODS A total of 540 women between 50 and 79 years of age were interviewed in Santiago, Chile. Women were allocated into two groups (H, high; L, low), according to their socioeconomic status. RESULTS Each group consisted of 270 women. The mean age and percentage of menopausal women were similar in both groups. Of the interviewed women, 47% had taken HRT at some time; marked differences between the two groups were observed (L, 15%; H, 79%; < 0.0001). In group H, the percentage of women who had been advised about HRT was close to 88%, whereas, in group L, the percentage was only 24%. Among the women who were informed about HRT, 83% ( = 253) had used it at some time. The percentage of women who used HRT for >2 years was similar in both groups. The main reason for not taking HRT in group H was fear of adverse effects, whereas the main reason for not taking it in group L was the lack of medical advice. CONCLUSIONS The percentage of women in the low socioeconomic group who use HRT is low. Medical advice is fundamental to increasing HRT use in this group.
Collapse
Affiliation(s)
- Juan E Blümel
- Hospital Barros Luco-Trudeau, Department of Medicine, Universidad de Chile, Santiago de Chile, Chile
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Gallus S, Negri E, Chatenoud L, Bosetti C, Franceschi S, La Vecchia C. Post-menopausal hormonal therapy and gallbladder cancer risk. Int J Cancer 2002; 99:762-3. [PMID: 12115514 DOI: 10.1002/ijc.10411] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The relation between post-menopausal hormone replacement therapy (HRT) and gallbladder cancer was analyzed in women above age 45 years, using data of a case-control study conducted in Italy between 1985 and 1997, on 31 incident, histologically confirmed cases and 3,702 controls in hospital for acute, non-neoplastic conditions. The multivariate odds ratio (OR) was 3.2 (95% confidence interval: 1.1-9.3) for those who had ever used HRT and the OR tended to rise with longer duration. Although based on small numbers, due to the rarity of the disease, these findings provide the first direct epidemiological evidence of an association between HRT and gallbladder cancer.
Collapse
Affiliation(s)
- Silvano Gallus
- Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
| | | | | | | | | | | |
Collapse
|
20
|
General and medical factors associated with hormone replacement therapy among women attending menopause clinics in Italy. Menopause 2001; 8:290-5. [PMID: 11449088 DOI: 10.1097/00042192-200107000-00012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of the study was to analyze medical and general factors associated with hormone replacement therapy (HRT) use in women attending a network of menopause clinics in Italy. DESIGN Between 1997 and 1999, we conducted a large cross-sectional study on the characteristics of women around menopause attending a network of first level outpatient menopause clinics for general counseling about menopause or treatment of menopausal symptoms. All women consecutively observed during the study period at the participating centers were eligible for the study. A total of 42,464 women (mean age 54 years) entered the study. The characteristics of women who had at some time used HRT were compared with those of women who were never users. RESULTS Of the 42,464 women considered, 4,909 (11.6%) reported having used HRT at some time. In comparison with premenopausal women, the odds ratio (OR) of HRT use was 2.1 and 4.0, respectively, in women with natural and surgical menopause; the frequency of use tends to be lower in women with later age at menopause. In comparison with women reporting primary school education, the OR was 1.4 in women with a secondary or university degree. In comparison with nulliparity, the OR of HRT use was 0.7 (95% confidence interval [CI] 0.6-0.7) in women with two or more births. HRT use was less frequent in women reporting a history of diabetes (OR 0.7, in comparison with women with no history, 95% CI 0.5-0.9) and cardiovascular diseases (OR 0.8, 95% CI 0.7-0.8) and more frequent in women with a history of osteopenia/osteoporosis (OR 1.2, 95% CI 1.0-1.5), but the latter finding was not statistically significant. CONCLUSION The results of the study indicate that HRT use is more common in this population in women of higher education with early age at menopause and with a history of osteoporosis/osteopenia and less frequent in women with a history of cardiovascular disease and diabetes.
Collapse
|
21
|
Chiaffarino F, Pelucchi C, Parazzini F, Negri E, Franceschi S, Talamini R, Conti E, Montella M, La Vecchia C. Reproductive and hormonal factors and ovarian cancer. Ann Oncol 2001; 12:337-41. [PMID: 11332145 DOI: 10.1023/a:1011128408146] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Menstrual, reproductive and hormonal factors have been related to ovarian cancer risk, but further quantification of their role in various populations is required. PATIENTS AND METHODS Cases were 1031 women, below age 79, with incident, histologically confirmed epithelial ovarian cancer, and controls 2411 women, admitted between 1992 and 1999 to a network of hospitals in 4 Italian areas for acute, non-neoplastic, diseases. Odds ratios (OR) were obtained using multiple logistic regression. RESULTS Multiparity was associated with a significant reduction in risk of ovarian cancer (OR = 0.6 for 3, and 0.5 for > or = 4 births). No consistent association was observed with time since first or last birth, nor with spontaneous or induced abortions. Late age at menarche (OR = 0.8), and early menopause (OR = 0.6) were inversely related to risk, as did long-term oral contraceptive use (OR = 0.5, for > or = 5 years). Hormone replacement therapy in menopause was associated with a non-significantly elevated risk (OR = 1.4). The pattern of risk was similar for women with and for those without family history of breast or ovarian cancer. CONCLUSIONS This uniquely large study confirms and further quantities the relation between hormonal and reproductive factors and ovarian cancer. The pattern of risk observed cannot be totally explained by a role of ovulation in ovarian carcinogenesis.
Collapse
Affiliation(s)
- F Chiaffarino
- Istituto di Ricerche Farmacologiche Mario Negri, Università degli Studi di Milano, Milan, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|