USPSTF Maintains Stance Against Using Hormone Therapy to Prevent Chronic Conditions — Physician’s First Watch

Medical News |
May 17, 2017

USPSTF Maintains Stance Against Using Hormone Therapy to Prevent Chronic Conditions

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

The U.S. Preventive Services Task Force, in a draft recommendation statement, is again advising against the use of hormone therapy to prevent chronic conditions in postmenopausal women.

In particular, the task force recommends against use of combined estrogen-progestin for this purpose, and against estrogen alone in women who've had a hysterectomy. The grade D recommendations are in line with the group's prior recommendations, issued in 2012 and 2005.

While the USPSTF found evidence that hormone therapy offers some benefits, including reduced risks for fracture and diabetes, it found evidence of more potential harms, including increased risks for invasive breast cancer (with estrogen-progestin only), venous thromboembolism, stroke, dementia, gallbladder disease, and urinary incontinence.

The recommendations do not apply to hormone therapy for the treatment of menopausal symptoms, such as hot flashes and night sweats.

Reader Comments (1)

Ellen Grant MBChB,DOstRCOG Physician, Obstetrics/Gynecology, Retired

It is wrong to imply that estrogens alone do not cause breast cancer .Beral and colleagues wrote that the WHI studies found “remarkably similar” increased risks of HT-associated breast cancer as the Million Women Study (MWS) and the worldwide Collaborative Group’s study (in which 80% of HT users had used estrogen-only preparations). The estimated excess incidence of breast cancer with estrogens increased from 2 to 6 per 1000 users in the Collaborative study and from 1.5 to 5 per 1000 users in the MWS for 5 and 10 years of use. The excess incidence for progestin/estrogen HT increased from 6 to 18 per 1000 users in for 5 and 7 years’ use in the WHI trial and from 6 to 19 per 1000 for 5 to 10 years of use in the MWS. Progestin containing HT caused four times more breast cancer than estrogen HT in both the WHI trial and the MWS. Longer use of estrogen HT or combination HT for up to 10 years trebled breast cancer risks compared with use for up to five years.

Beral V. Banks E, Reeves G, Bull D, on behalf of the Million Women Study collaborators. Breast cancer and hormone replacement therapy: the Million Women Study. Lancet 2003;362:1330-1331.

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