Evaluation of hormone replacement therapy use by the sales figures

Trends in Prescribing Menopausal Hormone Therapy and Bisphosphonates in Australia and Manitoba, Canada and Adherence to Recommendations

Background: Recommendations for using menopausal hormone therapy (MHT) and bisphosphonates for postmenopausal osteoporosis management have changed over time. After the release of the Women's Health Initiative (WHI) trial results in 2002, new evidence on risks and benefits of MHT became available, and newer guidelines generally specify that MHT should not be prescribed for prevention of chronic disease, including osteoporosis. This raises the question of whether bisphosphonate prescribing changed over time to compensate for the decrease in MHT use. Materials and Methods: We examined trends in dispensed prescriptions in Australia (national) and Canada (province of Manitoba) in relation to prescribing recommendations. Administrative data were used to describe dispensing patterns and changes for persons of all ages from 1996 to 2008, and for women aged 50 to ≥80 years from 2003 to 2008 in Australia and 1996 to 2008 in Canada. Results: In both geographic settings, MHT dispensing increased 1996-2001, peaked in 2001, and declined substantially thereafter (67% reduction in MHT prescriptions for Australia; 64% reduction for Manitoba, Canada to 2008). From 2003 to 2008, the number of MHT prescriptions declined among all age groups in both settings, with the highest declines among women in their 50s. Concurrently, bisphosphonate dispensing increased until 2005 (2001-2005: 260% increase in the number of prescriptions in Australia; 125% increase in Manitoba) and stabilized thereafter, in both settings. Annual bisphosphonate dispensing rates increased 4.1-10.9% for women in their 70s and 80s in Australia and Manitoba during the period studied. Conclusions: Based on dispensed prescriptions data, more recent guidelines for MHT and bisphosphonates use for postmenopausal osteoporosis, which were updated during the study period (and are still consistent with the current guidelines), appear to have been broadly adhered to in both settings.

Reversal of the hip fracture secular trend is related to a decrease in the incidence in institution-dwelling elderly women

In this prospective 10-year study in elderly aged 60 years and over, there was a 1.3% per year reduction in the standardized incidence of hip fracture in women but not in men. This decrease was mainly due to changes in the standardized incidence of hip fracture in institution-dwelling women.

INTRODUCTION

A decrease in age-adjusted hip fracture incidence has been recently demonstrated in some countries. Since a large proportion of hip fractures occur in nursing homes, we analyzed whether this decreasing trend would be more detectable in institution-dwelling elderly compared with community-dwelling elderly.

METHODS

All hip fracture patients aged 60 years and over were identified in a well-defined area. Incidence of hip fracture, age- and sex-adjusted to the 2000 Geneva population, was computed in community- and institution-dwelling elderly.

RESULTS

From 1991 to 2000, 1,624 (41%) hip fractures were recorded in institutionalized-dwelling elderly and 2,327 (59%) in community-dwelling elderly. The standardized fracture incidence decreased by 1.3% per year in women (p = 0.039), but remained unchanged in men (+0.5%; p = 0.686). Among institution-dwelling women, hip fracture incidence fell by 1.9% per year (p = 0.044), whereas it remained stable among community-dwelling women (+0.0%, p = 0.978). In men, no significant change in hip fracture incidence occurred among institution- or community-dwelling elderly.

CONCLUSIONS

The decrease in the standardized hip fracture incidence in institution-dwelling women is responsible for the reversal in secular trend. Future research should include stratification according to the residential status to better identify the causes responsible for the trend in hip fracture incidence.

Incidence of hip fracture over a 10-year period (1991-2000): reversal of a secular trend

INTRODUCTION

Hip fractures are a major cause of burden associated with osteoporosis in terms of mortality, disability, and costs. With the ageing of the population, a marked increase in the number of fractures is expected. Furthermore, many studies reveal an increase of the age-adjusted hip fracture incidence. We specifically examined secular changes in the incidence of hip fracture in women and men aged 50 years and over in the well-defined area of Geneva, Switzerland.

MATERIALS AND METHODS

All hip fractured patients were retrospectively identified from the computer medical records of the main hospital, which is receiving 95% of hip fractures occurring in a well-defined area.

RESULTS

From 1991 to 2000, 4115 hip fractures were recorded in 2981 women and 822 men with a mean age (+/-S.D.) of 83.1+/-8.9 and 78.3+/-11.6 years, respectively. A second hip fracture occurred in 276 women (9.3%) and 36 men (4.4%), on average 2.1+/-1.9 (median 1.44) years after the first event without gender difference. The overall incidence of hip fractures was 455 (95% CI: 439-471) per 100,000 person-years in women and 153 (95% CI: 143-163) in men. The number of hip fractures remained constant (412 (95% CI: 397-426)), but the mean age of these patients increased each year by 0.13 year in women (p=0.019) and by 0.04 year in men (NS). Furthermore, the age-adjusted incidence of hip fractures, standardized to the 2000 Geneva population, decreased significantly by 1.4% (95% CI: -2.6 to -0.1) per year in women (p=0.021), but remained stable in men (0.5% (95% CI: -1.7 to +2.8) per year, p=0.66). The overall female/male ratio of hip fracture incidence was 2.99 (95% CI: 2.80-3.18, p<0.001) and significantly decreased by 0.07 (95% CI: -0.13 to -0.01) per year (p=0.024).

CONCLUSION

Despite an increase in the population at risk and in the mean age of hip fractured women, there was a significant decrease in age-adjusted incidence in women but not in men. These results may suggest a reversal of the previously observed secular trend.

Hormone replacement therapy, mammography screening and changing age-specific incidence rates of breast cancer: an ecological study comparing two European populations

BACKGROUND

In 2003, for the first time, US breast cancer incidence rates have fallen. Experts argue whether this is due to the reduced uptake of screening mammography or to lower use of Hormone Replacement Therapy (HRT). This study aims to disentangle the respective impact of screening and HRT on age-incidence rates and histology of breast cancer, by comparing two populations with comparably high levels of screening mammography, but with different prevalence of HRT.

METHODS

We included all invasive breast cancers recorded at the Geneva cancer registry (n = 4,909) and the Netherlands Cancer Registry (n = 152,428) between 1989-2003. We compared age-specific incidence rates and trends in histological subtyping between the two populations.

RESULTS

Between 1989-1991, incidence rates increased with age in both populations. In 2001-2003, women aged 60-64 years showed highest incidence rates in Geneva, while in the Netherlands incidence rates continued to increase with age. The annual increase in ductal cancer incidence was similar in the Netherlands (2.3%) and Geneva (2.5%), but the annual increase in lobular cancer was sharper in Geneva (10%) than in the Netherlands (5%).

CONCLUSION

The sharp differences in age distribution and histological subtyping of breast cancer between two European populations are not attributable to screening, since both populations have a high uptake of mammography screening. Since the prevalence of HRT use is very high in Geneva and rather low in the Netherlands, HRT may explain these discrepancies. However, other etiological factors and differences in histological assessment may also have played a role.

Remarkable change in age-specific breast cancer incidence in the Swiss canton of Geneva and its possible relation with the use of hormone replacement therapy

Background

This article aims to explain the reasons for the remarkable change in age of breast cancer occurrence in the Swiss canton of Geneva.

Methods

We used population-based data from the Geneva cancer registry, which collects information on method of detection, stage and tumour characteristics since 1975. For patients diagnosed between 1997–2003, we obtained additional information on use of hormone replacement therapy from a large prospective study on breast cancer. Using generalized log linear regression analysis, we compared age-specific incidence rates with respect to period, stage, oestrogen receptor status, method of detection and use of hormone replacement therapy.

Results

In the periods 1975–1979 and 1985–1989, breast cancer risk increased with age, showing the highest incidence rates among women aged ≥ 85 years. From 1997, the age-specific incidence curve changed completely (p < 0.0001), showing an incidence peak at 60–64 years and a reduced incidence among elderly women. This incidence peak concerned mainly early stage and oestrogen positive cancers and was exclusively observed among women who ever used hormone replacement therapy, regardless whether the tumour was screen-detected or not.

Conclusion

The increasing prevalence of hormone replacement therapy use during the 1990s could explain the important change in age-specific breast cancer incidence, not only by increasing breast cancer risk, but also by revealing breast cancer at an earlier age.

A Psycho-Educational Program for Improving Women’s Attitudes and Coping With Menopause Symptoms

OBJECTIVE

To examine the impact of participation in a psycho-educational program on women's attitudes toward menopause, the perceived severity of their symptoms, and the association between the two.

DESIGN

Quasi-experimental. Data were gathered at baseline and 3 months after termination of the program.

SETTING

Two health maintenance organization clinics.

PARTICIPANTS

Eighty-two healthy 40- to 60-year-old women who chose to participate in the study. Thirty-six women participated in the program, and 46 women comprised the control group.

INTERVENTION

Program participants met for 10 weekly sessions to receive information from a professional team on subjects related to menopause and to share and discuss their experiences.

MAIN OUTCOME MEASURES

Attitudes toward menopause and severity of menopause symptoms.

RESULTS

The more negative the attitudes, the higher was the severity of symptoms. Participants reported significant improvements in attitudes and reductions in symptom severity compared to their own baseline scores and compared with the control group.

CONCLUSIONS

Participation in a program that combines delivery of information and processing of experiences on the cognitive, emotional, and social levels may improve women's attitudes toward menopause and ease the perceived severity of their symptoms, thereby increasing quality of life.

Important increase of invasive lobular breast cancer incidence in Geneva, Switzerland

A recent paper from the United States reported a sharp and unexplained increase in invasive lobular breast cancer incidence since 1977 (Li et al., Cancer 2000;88:2561-9). We investigated if this trend was also present in Geneva, Switzerland, where breast cancer incidence is one of the highest in Europe. We analyzed trends in breast cancer incidence according to histologic subtype, age and stage, to clarify the pattern. Our population-based study includes all histologically confirmed invasive breast carcinomas (n = 6,247) recorded between 1976 and 1999 at the Geneva Cancer Registry. Breast histology was classified as ductal carcinoma, lobular carcinoma and other. Incidence trends were studied by log-linear regression analyses. Models including effects of age, period and birth cohorts were used to describe rising incidence trends. The incidence of ductal carcinoma increased 1.2% per year (p(trend) < 0.001) from 85.2 to 110.1/100,000. This increase concerned women aged 50-69 years and early-stage tumors. Lobular cancer incidence increased disproportionately (14.4% per year, p(trend) < 0.01) and rose from 2.9 to 20.5/100,000. This increase affected all age categories and both localized and advanced stages. In addition, a strong age-cohort effect was present (p < 0.05), and women aged 50-59 years born after 1944 experienced the most marked increase. Our study shows a disproportionate increase of lobular breast cancer incidence compared to ductal cancer incidence. Contrary to ductal cancer, trends for lobular cancer are unlikely to be explained by increased use of screening mammography. Other explanations must be researched, in particular the role played by hormone replacement therapy.

Prevalence and determinants of hormone replacement therapy in German women 1984-1995

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.

[Hormonal replacement therapy in Spain]

BACKGROUND

The consumption of hormonal replacement therapy (HRT) in Spain is not known. Therefore, we have conducted a study to know the mean features of that consumption and to find out the prevalence of use among women older than 40.

SUBJECTS AND METHOD

To know the consumption, we have used the information contained in ECOM database from the Ministry of Health regarding medicines sold to the Spanish Health System. Also, data gathered by the General Practitioner Sentinel Network of Castilla y León had been used. The data of consumption are presented in daily defined dose per 1000 women more than 40 years (DHD); prevalence of use per year and for ages was also estimated.

RESULTS

The HRT consumption in Spain throughout the National Health System was 6,94 DHD in 1989 and 39.92 DHD in 1999. The percentage of women using this therapy was 0.7% in 1989 and 3,4 in 1999; the group 50-54 years had the highest prevalence of use, 10,84% (IC 95%, 10.66-11.01).

CONCLUSIONS

The release into the market of those transdermal forms of HRT facilitated an increase in the consumption. Nonetheless, the proportion of postmenopausal women on HRT in Spain is lower than that of the other countries from the European Union. The proportion of women treated with estrogens and progestins is also small compared with current recommendations.