Menopausal Hormone Therapy and Breast Cancer: Evidence from Randomized Clinical Trials

master's thesis

• Title (croatian): Hormonsko nadomjesno liječenje i karcinom dojke: Dokazi iz randomiziranih kliničkih ispitivanja
• Author: Tessa Grospić Hrkać
• Mentor: Dinka Pavičić Baldani (mentor)
• Committee member: Dinka Pavičić Baldani (predsjednik povjerenstva)
• Committee member: Lana Škrgatić (član povjerenstva)
• Committee member: Marina Šprem Goldštajn (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2024-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

The use of menopausal hormone therapy (MHT) significantly declined after 2002, primarily due to the Women's Health Initiative's (WHI) report suggesting that the combination of conjugated equine estrogen (CEE) and medroxyprogesterone acetate (MPA) increased breast cancer risk and did not enhance quality of life. More recently, WHI publications have recognized MHT as the
most effective treatment for managing menopausal vasomotor symptoms, reporting that CEE alone decreases the risk of breast cancer by 23% and reduces breast cancer mortality by 40%. The only remaining concern is a slight increase in breast cancer incidence with CEE and MPA (1 per 1,000 women per year), but with no increased risk of breast cancer mortality. Recently, reanalyses of the WHI trial have been published that dispute even this claim about breast cancer risk, pointing out the WHI's presentation of insignificant results as if they were conclusive, misinterpretation of its own data, and the false claim that the WHI findings, and consequent decline in the use of MHT, led to a reduction in breast cancer incidence in the United States. As a result, a generation of women has been largely deprived of MHT due to this widely publicized misinterpretation of the data. Furthermore, clinical trials performed on other types of progesterone do not agree with the results obtained from the WHI study, which analyzed the use of one specific type of progesterone - medroxyprogesterone acetate. This article aims to present and interpret relevant randomized trials, with the intention of assisting patients and physicians in making informed decisions about the use of MHT.

Abstract (croatian)

Korištenje hormonskog nadomjesnog liječenja (HNL) značajno se smanjilo nakon 2002. godine, prvenstveno zbog izvješća Inicijative za zdravlje žena (WHI) koje sugerira da kombinacija konjugiranog konjskog estrogena (CEE) i edroksiprogesteron acetate (MPA) povećava rizik od raka dojke, a ne poboljšava kvalitetu života. Nedavno objavljene reanalize WHI ispitivanja
prepoznale su HNL kao najučinkovitije liječenje za vazomotornih menopauzalnih tegoba, izvješćujući da primjenjena samih CEE smanjuje rizik od raka dojke za 23% te smrtnost od raka dojke za 40%. Jedina preostala zabrinutost je blagi porast incidencije raka dojke uz korištenje kombinacija CEE i MPA (1 na 1000 žena godišnje), ali bez povećanog rizika od smrtnosti od raka dojke. Nedavno su objavljene ponovne analize WHI ispitivanja koje osporavaju čak i ovu tvrdnju
o riziku od raka dojke, ističući predstavljanje beznačajnih rezultata WHI ispitivanja kao da su konačnih, pogrešno tumačenje vlastitih podataka i lažnu tvrdnju da su nalazi WHI-a i posljedični pad korištenja HNL, doveli do smanjenje incidencije raka dojke u Sjedinjenim Državama. Kao rezultat toga, zbog ovog objavljenog pogrešnog tumačenja podataka, jednoj generaciji žena je uskraćeno korištenje HNL-a. Nadalje, klinička ispitivanja provedena sa drugim vrstama progesterona bila u suglasnoti s rezultatima dobivenim iz studije WHI, koja je analizirala upotrebu jedne specifične vrste progesterona - medroksiprogesteron acetata. Cilj ovog članka je predstaviti i protumačiti relevantna randomizirana ispitivanja, s namjerom da pomogne pacijentima i liječnicima u donošenju informiranih odluka o upotrebi HNL-a.

• Keywords: Menopausal Hormone Therapy; Breast cancer; Randomized Clinical Trials
• Keywords (croatian): hormonsko nadomjesno liječenje; karcinom dojke; randomizirana klinička ispitivanja
• Language: croatian
• URN:NBN: urn:nbn:hr:105:565009
• Study programme: Title: Medicine (in English language); Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-10-18 07:41:42