Commentary on medical news by a practicing physician.

  • Epocrates MedSearch Drug Lookup


    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

    ''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.''
    -Robert Ehrlich, drug advertising executive.

    "Opinions are like sphincters, everyone has one." - Chris Rangel

    email: medpundit-at-ameritech.net

    or if that doesn't work try:


    Medpundit RSS

    Quirky Museums and Fun Stuff

    Who is medpundit?

    Tech Central Station Columns

    Book Reviews:
    Read the Review

    Read the Review

    Read the Review

    More Reviews

    Second Hand Book Reviews


    Medical Blogs


    DB's Medical Rants

    Family Medicine Notes

    Grunt Doc




    Code Blog: Tales of a Nurse

    Feet First

    Tales of Hoffman

    The Eyes Have It


    SOAP Notes


    Cut-to -Cure

    Black Triangle



    Kevin, M.D

    The Lingual Nerve

    Galen's Log



    Doctor Mental



    Finestkind Clinic and Fish Market

    The Examining Room of Dr. Charles

    Chronicles of a Medical Mad House



    Health Facts and Fears

    Health Policy Blogs

    The Health Care Blog

    HealthLawProf Blog

    Facts & Fears

    Personal Favorites

    The Glittering Eye

    Day by Day


    The Business Word Inc.

    Point of Law

    In the Pipeline


    Tim Blair

    Jane Galt

    The Truth Laid Bear

    Jim Miller

    No Watermelons Allowed

    Winds of Change

    Science Blog

    A Chequer-Board of Night and Days

    Arts & Letters Daily

    Tech Central Station





    The Skeptic's Dictionary

    Recommended Reading

    The Doctor Stories by William Carlos Williams

    Pox Americana: The Great Smallpox Epidemic of 1775-82 by Elizabeth Fenn

    Intoxicated by My Illness by Anatole Broyard

    Raising the Dead by Richard Selzer

    Autobiography of a Face by Lucy Grealy

    The Man Who Mistook His Wife for a Hat by Oliver Sacks

    The Sea and Poison by Shusaku Endo

    A Midwife's Tale by Laurel Thatcher Ulrich



    American Academy of Pediatrics

    General Health Info

    Travel Advice from the CDC

    NIH Medical Library Info



    Saturday, August 09, 2003

    Raging Hormones: This has been a landmark week for indulgence in hormone hysteria. British researchers say that taking hormone replacement therapy increases the risk of developing breast cancer by twenty-two percent :

    The Lancet report was based on the ''Million Woman Study'' which surveyed 1,084,110 women in the United Kingdom aged 50 to 64. They were recruited between 1996 and 2001, and followed up for cancer incidence and death.

    Professor Valerie Beral, director of the Cancer Research UK Epidemiology Unit and lead author of the study, said there was ''overwhelming evidence'' that the combination therapy was associated with a greater cancer risk.

    Among 1,000 postmenopausal women who do not use HRT, there will be around 20 breast cancer cases between the ages of 50 and 60, Beral said.

    In every 1,000 women who begin 10 years of HRT at the age of 50, there will be five extra cases among estrogen-only users and 19 among estrogen-progestin combination users, she said.

    Dr. JoAnn Manson of the Harvard University Medical School commented that ''the evidence is now compelling that estrogen plus progestin is more deleterious to the breast than estrogen alone.''

    Unfortunately, the full article isn't available without a subscription, but the abstract is:

    1,084,110 UK women aged 50-64 years were recruited into the Million Women Study between 1996 and 2001, provided information about their use of HRT and other personal details, and were followed up for cancer incidence and death.

    ...Half the women had used HRT; 9364 incident invasive breast cancers and 637 breast cancer deaths were registered after an average of 2·6 and 4·1 years of follow-up, respectively.

    The abstract doesn't make clear whether that was 9,364 total breast cancers out of the more than 1,000,000 women in the study or if that figure is just for the women who used hormones. Either way, it's an awfully small proportion. The rest of the abstract expresses the results only in terms of relative risk - which is meaningless in the face of such small numbers.

    Meanwhile, here in the United States, the Women's Health Initiative people now say that hormone replacement therapy doubles the risk of heart disease:

    "For American women who have been told that hormones are still safe if taken short-term, there was more bad news Thursday.

    In a study published in the New England Journal of Medicine, researchers report that women taking a leading combination hormone therapy for menopause face nearly double the risk of a heart attack in the first year of use."

    Here’s what the study actually found: 188 out of 8506 HRT users had coronary heart disease (defined as a heart attack, fatal or nonfatal). That’s just 2.2% of estrogen users. For non-users the incidence was 147 out of 8102, or 1.8%. Not much of a difference.

    They then expanded the definition to include women who had symptoms of heart disease. But expanding the definition narrowed the gap even further. 369 out of 8506 users, or 4.3% had evidence of coronary artery disease, compared to 356 out of 8102 nonusers, or 4.4%. That's hardly a doubling of risk, now, is it?

    Interestingly, another study in the same issue that involved measuring the degree of coronary artery stenosis over time, confirms that there's no difference in the progression of coronary artery disease between estrogen users and nonusers. But that study hasn't gotten nearly the press that the first one has.

    The only thing that we can conclude from the studies done to date on hormone replacement therapy and the heart is that hormones don't prevent heart disease. And they don't appear to cause it, either.

    posted by Sydney on 8/09/2003 10:47:00 PM 0 comments


    Post a Comment

    This page is powered by Blogger, the easy way to update your web site.

    Main Page


    Home   |   Archives

    Copyright 2006