The WHI trial results of 2002 concluded that the risks of using HRT outweighed the benefits. But industry had too much to lose. Like the contraceptive pill, hormone replacement therapy was one of the biggest money spinners of all time and history had shown that healthy older women are a target group easily convinced. So as the years have gone by the risks of cancer heart attack and stroke have been downplayed and the possible benefits to bone and menopause management enthusiastically revisited. Although many women have stopped using HRT, some have continued and others returned, reassured by their doctors that the risks are minimal.
But the damning evidence keeps coming…
Further analysis of the WHI trial has found that taking combined oestrogen plus progestin longer than 5-years nearly doubles subsequent breast cancer risk each year. [i] And among current smokers using combined HRT there was an increased risk for death from non-small-cell lung cancer. It was reported that 1 in 100 current smokers experienced an avoidable death during the 8 years of the study. The death rate among women who had been most regular with their HRT during the trial was 53 percent higher in the hormone group than in the placebo group. [ii]
A Dutch study published in February 2009 found that women taking HRT for more than six months at a time are twice as likely to have a malignant melanoma. The investigation, one of the largest ever carried out on oestrogen use and malignant melanomas, found a sharp increase in risk.[iii]
A study published in the journal Cancer in March 2009 reports that breast cancer risk increases steadily during the first three years of hormone therapy and the combination of oestrogen and progesterone is the HRT regimen most likely to be the source of that danger.[iv] In addition, women who used oestrogen for 10 years or longer had a 50 percent increase in risk of invasive lobular breast cancer.
A Nationwide Danish prospective cohort study published in the Journal of the American Medical Association in July 2009 concluded that regardless of the duration of use, the formulation oestrogen dose, regimen, progestin type, and route of administration, hormone therapy was associated with an increased risk for ovarian cancer. [v]
More dodgy science
Physicians rely on medical literature to keep abreast of safety profiles. A colleague’s name on a peer-reviewed article gives confidence when making prescribing decisions. But it has come to light that over several years Wyeth pharmaceuticals hired medical ghost-writers to create favourable articles about HRT that would later add the name of a reputable physician, giving the appearance that they were the writer. A New York Times article ‘Medical Papers by Ghostwriters Pushed Therapy’ of August 4th documents the practice which is also known to be used by other pharmaceutical companies. Earlier this year it came to light that Merck went so far as to create a fake medical journal called The Australasian Journal of Bone and Joint Medicine in order to promote Vioxx and Fosamax. World osteoporosis authorities were named on the editorial board, giving great credibility to what was nothing but a marketing tool. Unsuspecting doctors receiving the literature would be hard pushed to see through the deception.
[i] Chlebowski R T., et al. Breast Cancer after Use of Estrogen plus Progestin in Postmenopausal Women New England Journal of Medicine 2009; 360:573-587
[ii] Chlebowski RT, Schwartz A, Wakelee H, et al. Non-small cell lung cancer and estrogen plus progestin use in postmenopausal women in the Women’s Health Initiative randomized clinical trial. Presented at the 2009 annual meeting of the American Society of Clinical Oncology, May 29-June 2, 2009, Orlando, FL. Abstract CRA1500.
[iii] Koomen ER, et al Estrogens, oral contraceptives and hormonal replacement therapy increase the incidence of cutaneous melanoma: a population-based case-control study. Annals of Oncology. 2009 Feb;20(2):358-64. Epub 2008 Aug 25
[v] Mørch L.S., et al, Hormone Therapy and Ovarian Cancer JAMA. 2009;302(3):298-305