LETTER
Postmenopausal Hormone Therapy
Knight Steel
15 August 1993 | Volume 119 Issue 4 | Pages 347-348
TO THE EDITOR:
The superb review of hormone therapy in postmenopausal women [1] and the associated guidelines [2] did not address the following issues:
The possible increase in the risk for developing breast cancer associated with the use of estrogen plus progestin therapy (the most widely used hormone therapy) is the major deterrent to its use. Many studies of estrogen therapy show a "small increase in risk" among those using it for the longest duration; the data about estrogen plus progestin therapy appear inconclusive. Given the suggestion that any increased risk occurs only after long-term use, why not use the estrogen-progestin combination for only 5 or 10 years if studies show a significant increased risk?
Would there not also be a rationale for beginning estrogen-progestin therapy later in life than age 50 to maximize benefits and minimize risks?
Do the authors of the review and the College intend to update this analysis each year or at some other specified time period as new studies are reported?
The opinion expressed is that of the author and does not necessarily reflect the opinion of the World Health Organization.
1. Grady D, Rubin SM, Petitti DB, Fox CS, Black D, Ettinger B, et al. Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med. 1992; 117:1016-37.
2. American College of Physicians. Guidelines for counseling postmenopausal women about preventive hormone therapy. Ann Intern Med. 1992; 117:1038-41.
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