HRT and breast cancer : too much caution may obscure the benefits
Regarding HRT (hormone replacement therapy for menopause ) and breast cancer, too precautionary risk of obscuring the benefits , said the French Society of breast imaging and breast pathology at XXVIth Days which took place in Nancy .
The mechanism of menopause
Menopause is the cessation of ovarian production and can cause disorders of the climacteric ( hot flashes , sweating , insomnia, mental disorders , dry mucocutaneous ... ) more or less strong and enduring .
In France , more than 12 million women over 40 years. Each year, between 300 and 500 thousand reach the age of menopause : 33% 45-49 83% 50-54. In total, 10 million women are menopausal and it is estimated that 30-50 % of those aged 48 to 64 years taking HRT.
The relationship between the benefits and risks of HRT was considered favorable. These treatments have been widely prescribed to relieve climacteric symptoms , prevent osteoporosis, and even cardiovascular events .
Risk aversion sets in 2002
The publication in July 2002 , the results of two major studies , one American ( the Women's Health Initiative or WHI) , the other British ( the Million Women Study or MWS ) has challenged this report and also cast doubt well among prescribers and within the audience. So much so that a survey conducted by Sofres revealed in March 2004 , a third of women who were receiving HRT have interrupted temporarily or permanently, because of the information disseminated by the media, their doctor's advice or fear of developing cancer.
" The weight of numbers and risk aversion therefore affect the daily prescribing as much as that of the patient ," said the French Society for breast imaging and breast pathology . Now , she says , the results of these studies can not be extrapolated to the French situation . " You can not transpose the data obtained with a molecule to those that could be obtained with another molecule ," she insists .
Moreover , continues the learned society , the populations studied are not identical and the same product delivered at 50 or 70 years does not cause the same effects in breast level . " The scientific rigor , she says , requires taking into account the comparable parameters : age, incidence (number of new cases per year ) in a population of cancer , menopause , since last time , drugs .. . " .
According to her, the medical community and the media wanted to retain Anglo- Saxon studies that breast risk ( and cardiovascular risk ) . " It is also a risk previously known . Moreover , it is impossible to say that the increased risk of breast cancer is linked to a molecule rather than another . It is, however , demonstrated that the cardiovascular and metabolic impact of HRT depends heavily on both prescription and the age of patients , " she informs .
So the evaluation of the "variable" relationship between benefits and risks depending on the products used and the populations concerned must ultimately guide the prescriber. " By avoiding amalgams and keeping in mind that the goal of these treatments is to overcome the estrogen deficiency , HRT should be restored to its proper title, especially since it is not intended to be maintained for life, " concludes the French Society of breast imaging and breast pathology .
Different HRT
The term HRT covers very different from one country to the other realities.
The United States favored conjugated equine estrogens orally, while France uses natural estrogen combination products (mainly 17 beta estradiol) in a generally micronized progesterone .
In our country, the HRT exist in diverse forms (gel, spray, patches, pills ), with assays and association of different molecules modes.
The mechanism of menopause
Menopause is the cessation of ovarian production and can cause disorders of the climacteric ( hot flashes , sweating , insomnia, mental disorders , dry mucocutaneous ... ) more or less strong and enduring .
In France , more than 12 million women over 40 years. Each year, between 300 and 500 thousand reach the age of menopause : 33% 45-49 83% 50-54. In total, 10 million women are menopausal and it is estimated that 30-50 % of those aged 48 to 64 years taking HRT.
The relationship between the benefits and risks of HRT was considered favorable. These treatments have been widely prescribed to relieve climacteric symptoms , prevent osteoporosis, and even cardiovascular events .
Risk aversion sets in 2002
The publication in July 2002 , the results of two major studies , one American ( the Women's Health Initiative or WHI) , the other British ( the Million Women Study or MWS ) has challenged this report and also cast doubt well among prescribers and within the audience. So much so that a survey conducted by Sofres revealed in March 2004 , a third of women who were receiving HRT have interrupted temporarily or permanently, because of the information disseminated by the media, their doctor's advice or fear of developing cancer.
" The weight of numbers and risk aversion therefore affect the daily prescribing as much as that of the patient ," said the French Society for breast imaging and breast pathology . Now , she says , the results of these studies can not be extrapolated to the French situation . " You can not transpose the data obtained with a molecule to those that could be obtained with another molecule ," she insists .
Moreover , continues the learned society , the populations studied are not identical and the same product delivered at 50 or 70 years does not cause the same effects in breast level . " The scientific rigor , she says , requires taking into account the comparable parameters : age, incidence (number of new cases per year ) in a population of cancer , menopause , since last time , drugs .. . " .
According to her, the medical community and the media wanted to retain Anglo- Saxon studies that breast risk ( and cardiovascular risk ) . " It is also a risk previously known . Moreover , it is impossible to say that the increased risk of breast cancer is linked to a molecule rather than another . It is, however , demonstrated that the cardiovascular and metabolic impact of HRT depends heavily on both prescription and the age of patients , " she informs .
So the evaluation of the "variable" relationship between benefits and risks depending on the products used and the populations concerned must ultimately guide the prescriber. " By avoiding amalgams and keeping in mind that the goal of these treatments is to overcome the estrogen deficiency , HRT should be restored to its proper title, especially since it is not intended to be maintained for life, " concludes the French Society of breast imaging and breast pathology .
Different HRT
The term HRT covers very different from one country to the other realities.
The United States favored conjugated equine estrogens orally, while France uses natural estrogen combination products (mainly 17 beta estradiol) in a generally micronized progesterone .
In our country, the HRT exist in diverse forms (gel, spray, patches, pills ), with assays and association of different molecules modes.
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