Public Release:  Applying results of women's health initiative study to individual patients

For a few, hormone replacement therapy might be a good idea

American Association for the Advancement of Science

SEATTLE, WA--Scientists at the AAAS (Triple-A-S) Annual Meeting argued that women facing severe menopause symptoms should demand that their doctors take the time to help them balance the risks versus the benefits of hormone replacement therapy (HRT). AAAS is the American Association for the Advancement of Science.

"We're saying that physicians have to learn more about their patients' risk profile," said Susan Johnson, a gynecologist who is an investigator in the Women's Health Initiative study clinical trials. One of the WHI clinical trials, which studied the effects of a combination of estrogen and progestin on the prevention of chronic diseases, was ended in July 2002, after researchers found that combined HRT was putting women at risk for heart attacks, breast cancer, strokes and blood clots. "There are many women for whom HRT continues to be an excellent choice for the treatment of menopause related symptoms. In my clinical practice, I'm putting a lot of women back on HRT."

With the release of the results of the high profile WHI study, many physicians and their women patients have been struggling to weigh contradictory evidence from several studies, while balancing the advantages and disadvantages of various treatment options. Johnson and several of her colleagues on a panel at the AAAS Annual Meeting have been among those the doctors are turning to for guidance.

Johnson noted that in the past clinicians could recommend HRT for the treatment of menopause and several diseases. In that sense, the WHI is transforming the practice of gynecology, she said. "Now, several therapeutic options need to be presented to women who prefer not to use hormones, and more time must be spent in considering risk factors and prevention options for osteoporosis, heart disease, and other conditions."

Nonetheless, Johnson said, based on the WHI study, the risks exceed the benefits for asymptomatic women who are using HRT for prevention of conditions such as osteoporosis. Furthermore, WHI researcher Garnet Anderson noted, women might want to consider that the results released to the public were often the most conservative ones, particularly regarding breast cancer.

"In releasing these results in July 2002, a generally conservative statistical view of the data was given through use of unweighted statistics and inclusion of adjusted confidence intervals," said Anderson, a statistician with the Fred Hutchinson Cancer Research Center. "I'm going to explain how the assumptions behind the analyses and try to show how these led to the decision to end the study."

It's a familiar role for Anderson, who has received emails and faxes from physicians around the country who are struggling to understand the WHI results.

"The gynecological community's reaction to the WHI results was something akin to finding out that the world was round, and not flat," Johnson said. "The public health benefit of HRT had been so ingrained in training and practice that the understandable initial reaction of many gynecologists was skepticism, disbelief and for some, anger at and distrust of the scientific community."

Johnson and Anderson were among a group of epidemiologists, clinicians, and statisticians on a panel entitled, "HRT and WHI: How Science Informs Individuals' Health Decisions."

###

The American Association for the Advancement of Science (AAAS) is the world's largest general scientific society, and publisher of the journal, Science (www.sciencemag.org). AAAS was founded in 1848, and serves some 265 affiliated societies and academies of science, serving 10 million individuals. Science has the largest paid circulation of any peer-reviewed general science journal in the world, with an estimated total readership of one million. The non-profit AAAS (www.aaas.org) is open to all and fulfills its mission to "advance science and serve society" through initiatives in science policy; international programs; science education; and more. For the latest research news, log onto EurekAlert!, www.eurekalert.org, the premier science-news Web site, a service of AAAS.

Additional news from the AAAS Annual Meeting may be found online at www.eurekalert.org.

MEDIA NOTE: A news briefing on this research will take place at 12:00 p.m. Pacific Time, Friday, 13 February, during the AAAS Annual Meeting in Seattle, in the Eliza Anderson Amphitheater, Grand Hyatt Hotel. Further, these and other speakers will take part in a symposium titled, "HRT and WHI: How Science Informs Individuals' Health Decisions," at 2:30 p.m. Friday, 13 February, on the second floor of the Sheraton Hotel, Grand Ballroom C.

Press registration is located in the AAAS Press Center in Leonesa I of the Grand Hyatt Hotel.

AAAS is the world's largest general scientific society, dedicated to "Advancing science · Serving society."

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.