The document discusses hormone replacement therapy (HRT) and its risks and benefits. It analyzes data from randomized clinical trials and observational studies on combined HRT (estrogen and progestin) and estrogen-only therapy. The main findings are:
1) Combined HRT is associated with a higher risk of breast cancer, especially invasive lobular carcinoma, compared to estrogen-only therapy or no treatment. The risk increases with longer use.
2) Estrogen-only therapy is not conclusively linked to an increased breast cancer risk in clinical trials but some observational studies find a small elevated risk.
3) Both types of HRT improve menopausal symptoms but combined HRT carries greater health risks
This Journal Club presentation provides a summary and discussion of the following free access article published in UOG:
Perinatal outcome in women treated with progesterone for the prevention of preterm birth: a meta-analysis
A. Sotiriadis, S. Papatheodrou, G. Makrydimas
Volume 40, Issue 3, Date: September 2012, pages 257-266
It can be accessed here:
http://onlinelibrary.wiley.com/doi/10.1002/uog.11178/abstract
Cancer genetic testing and risk assessment overview.
This slide deck was the basis of a presentation to nurse practitioners and genetic counselors who are actively identifying and managing women at high risk of breast and ovarian cancer.
These are essentially mortgages that the banks knew they did not own, but were willing to break the law in order to put homeowners out on the streets to satisfy their insatiable greed for even more money.
This Journal Club presentation provides a summary and discussion of the following free access article published in UOG:
Perinatal outcome in women treated with progesterone for the prevention of preterm birth: a meta-analysis
A. Sotiriadis, S. Papatheodrou, G. Makrydimas
Volume 40, Issue 3, Date: September 2012, pages 257-266
It can be accessed here:
http://onlinelibrary.wiley.com/doi/10.1002/uog.11178/abstract
Cancer genetic testing and risk assessment overview.
This slide deck was the basis of a presentation to nurse practitioners and genetic counselors who are actively identifying and managing women at high risk of breast and ovarian cancer.
These are essentially mortgages that the banks knew they did not own, but were willing to break the law in order to put homeowners out on the streets to satisfy their insatiable greed for even more money.
SE DESCRIBE EL TRABAJO QUE ESTÁN REALIZANDO LOS OBREROS DEL SEÑOR A TIEMPO COMPLETO EN VENEZUELA EN SUS LABORES DE EVANGELIZACIÓN Y ENSEÑANZA, ASÍ COMO TAMBIÉN LA AYUDA QUE ESTÁN EFECTUANDO OTROS HERMANOS EN ESA MISMA OBRA
Как создать лендинг за одну ночь и успеть поспать?Михаил Белокоз
Михаил Белокоз - основатель nextteam.ru
Специально для limur.su
Как создать лендинг быстро? Как создать лендинг круто? А что делать если уже есть крутой лендинг? Как сделать полноценный сайт как у Apple? Есть ли жизнь после лендинга?
Больше информации о спикере: belokoz.ru
Here are slides from my 10-minute talk on breast cancer screening for an AACR webinar (Feb 16, 2017). I'll share the webinar link when that becomes available.
Covering Cancer News - Lessons from HealthNewsReview.orgGary Schwitzer
This is 1 of 2 presentations I made at the National Cancer Institute's Cancer Research in the Media workshop for Latin American journalists in Guadalajara on November 7, 2011
SE DESCRIBE EL TRABAJO QUE ESTÁN REALIZANDO LOS OBREROS DEL SEÑOR A TIEMPO COMPLETO EN VENEZUELA EN SUS LABORES DE EVANGELIZACIÓN Y ENSEÑANZA, ASÍ COMO TAMBIÉN LA AYUDA QUE ESTÁN EFECTUANDO OTROS HERMANOS EN ESA MISMA OBRA
Как создать лендинг за одну ночь и успеть поспать?Михаил Белокоз
Михаил Белокоз - основатель nextteam.ru
Специально для limur.su
Как создать лендинг быстро? Как создать лендинг круто? А что делать если уже есть крутой лендинг? Как сделать полноценный сайт как у Apple? Есть ли жизнь после лендинга?
Больше информации о спикере: belokoz.ru
Here are slides from my 10-minute talk on breast cancer screening for an AACR webinar (Feb 16, 2017). I'll share the webinar link when that becomes available.
Covering Cancer News - Lessons from HealthNewsReview.orgGary Schwitzer
This is 1 of 2 presentations I made at the National Cancer Institute's Cancer Research in the Media workshop for Latin American journalists in Guadalajara on November 7, 2011
Caren Stalburg, MD, MA presented to the 2016 annual Snow meeting of the Michigan Section of the American Congress of Obstetricians and Gynecologists (ACOG) about her program to train Michigan providers about the new Breast Density Notification Law (http://www.midensebreasts.org/).
Dr. Stalburg is Division Chief and Clinical Assistant Professor in the Division of Professional Education in the Department of Learning Health Sciences and Assistant Professor of Obstetrics and Gynecology in the University of Michigan Medical School.
Dr. Anne Peterson, MD, MPH explains how using family planning to safely time and space births improves maternal and child health and survival and reduces abortion rates. Dr. Peterson also explains how recent research has shown previous beliefs that some contraceptive methods were abortifacients to be inaccurate.
Thyroid Cancer, Anxiety and Depression - The patients' experience
Presentation at Genzyme symposium on differenciated thyroid cancer, Dec 5, 2015, Athens
2. Ovulation does
• Degeneration of not occur
women’s last
oocytes • There is no
corpus luteaum
• There is no follicular • FSH has a drastic
development
development increase
<[progesterone]
< [estrogens]
Diana Catarina Santos nº23271 07-07-2011
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3. Hot flashes;
Palpitations; Anxiety;
Night sweats. Insomnia;
Urogenital
Mood change; infections;
Cardiovascular
Vagina dryness; disease (CVD);
Poor memory.
Loss of libido Osteoporosis;
Alzheimer
Diana Catarina Santos nº23271 07-07-2011
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4. • Unopposed estrogen therapy - women with uterus – continuous
ET proliferation of endometrium – hyperplasia – endometrial cancer
• ET (eg: CEE) must only be used by hysterectomized women
• Combined hormone therapy uses a progestin plus estrogens to
CHT oppose them effects (eg: CEE+MPA)
• Can postmenopausal women trust in HRT? What are the risks?
• To answer the questions there were performed several randomized
clinical trials (RCTs) and observational studies
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5. Expectations Results
• Climacteric symptoms relief
• Climacteric symptoms relief
• Osteoporosis prevention
• Osteoporosis prevention
• Increase of stroke risk and CVD
• CVD prevention
• Increase of breast cancer risk
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6. CHT ET
Regiment
Duration of use selection (e.g.:
progestin type)
Diana Catarina Santos nº23271 07-07-2011
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7. Breast cancer risk for users of CHT (CEE+MPA) is higher
than for placebo group
RCTs Women’s Health Initiative (WHI) –> HR=1,26
Heart and Estrogen/Progestin Replacement Study (HERSII) -
> HR=1,30
Breast cancer risk in users of CHT is higher than in never
users
Observational
Million Women Study (MWS)
Studies
Collaborative Group Study –Reanalyzes of 51 studies
Shah Nirav, et al -> estimated the risk of 1,39 fold increase
for observational studies
Diana Catarina Santos nº23271 07-07-2011
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8. Breast cancer risk for users of CHT (CEE+MPA) is increased
in time against placebo group
RCTs 1 year – 8 more cases per 10 000 against placebo group
5,2 years – there are expected 46 more cases per 10 000
than in placebo group
Breast cancer risk for users also appeared to depend
on time Observational
MWS -> RR=1,63 (<5 years) and 2,21 (>5 years) Studies
Diana Catarina Santos nº23271 07-07-2011
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9. Observational data:
• Studies show that women using CHT sequentially (<15 days/mo) present
lower risk against continuous users;
• Others found an increased risk of 30% against non users for both strategies
of use;
After 5 years of discontinuing the hormonal therapy use, past and
current users have the same relative risk.
Diana Catarina Santos nº23271 07-07-2011
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10. Breast cancer risk for users of ET (e.g.: CEE alone)
presented no raise in the risk of breast cancer compared
with placebo
RCTs
WHI –>HR=0,77 (23% decrease)
Most of studies show a higher breast cancer risk in users
compared with never users Observational
MWS -> RR=1,30 Studies
Collaborative Group Study -> RR=1,34
E3N cohort study-> RR=1,29
Shah Nirav, et al -> estimated the risk of 1,16 fold increase as
a review of observational studies
Diana Catarina Santos nº23271 07-07-2011
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11. Most observational studies found that:
• Breast cancer increases with the course of time for current users;
• Breast cancer has a higher risk for past users;
• After discontinuation of ET, breast cancer risk decreases;
• Breast cancer risk increase for ET is smaller than the risk that these
studies presented for CHT, according with time.
Other observational studies presented similar results to WHI studies.
Diana Catarina Santos nº23271 07-07-2011
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12. Invasive lobular carcinoma (ILC) is more difficult to detect by
mammography but have better prognosis than invasive ductal
carcinoma (IDC) [Christopher I., et al]
CHT
• CHT are associated with 2.0 – 3.9 fold increased risk of ILC, but generally
not with IDC.
ET
• Both ILC and IDC risks remain unaltered, even after prolonged use of 25
years.
Diana Catarina Santos nº23271 07-07-2011
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13. Female primates – Macaca fascicularis
• Breast epithelial proliferation increases –
CEE+MPA high breast cancer risk
• Breast epithelial proliferation increases –
CEE alone high breast cancer risk
• Breast epithelial proliferation is not altered
Tibolone with this therapy
• Significant increase for both ductal and
E2+MPA lobular epithelial proliferation
• Breast epithelial proliferation (ductal and
E2+P4 lobular) remains unaltered
Diana Catarina Santos nº23271 07-07-2011
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14. CHT
leads ET
Abnormal Mammograms are
to: mammograms not compromised
Diagnostic delay
6,9% raise in
breast cancer 2,9% raise in
density breast cancer
Worse tumors and density
increased mortality
Diana Catarina Santos nº23271 07-07-2011
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15. NHS (Nurses Health Study) and the majority of observational studies
showed a decrease in the risk of death for HRT users compared with never
users;
These results are expected because:
• Women taking HRT are more under medical supervision;
• Breast cancer can be detected and treated earlier.
Although observational studies have a lot of limitations:
• They combined CHT and ET results;
• Selection criteria is varied;
• Difference in women’s age (WHI comprised older women)
Diana Catarina Santos nº23271 07-07-2011
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16. Women taking CEE+MPA (CHT) have a high breast cancer risk, compared with
women taking other HRT or compared with non-users;
The risk is more apparent with continuous CHT and for ILC;
Although the differences between RCTs and observational studies ET is
associated with less risk than CHT is;
Replacing MPA for other progestin may provide more safety for users;
Mortality is still a controversial.
HRT is associated with a small but significant increase in breast cancer
risk
Diana Catarina Santos nº23271 07-07-2011
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17. Benefits Risks
Quality of life Breast cancer
increase
Osteoporosis
prevention Stroke / CVD
CVD Diagnostic
prevention delay/Mortality
Diana Catarina Santos nº23271 07-07-2011
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