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Re: Progesterone and Breast cancer....LONGFrom: Joanne Bulley, MD (jbulley@cheshire.net)Fri Jan 28 22:55:39 2000
I have problems with this study. First in the opening Results area it states: R"esults During follow-up, 2082 cases of breast cancer were identified. Increases in risk with estrogen only and estrogen-progestin only were restricted to use within the previous 4 years (relative risk [RR], 1.2 [95% confidence interval {CI}, 1.0-1.4] and 1.4 [95% CI, 1.1-1.8], respectively); the relative risk increased by 0.01 (95% CI, 0.002-0.03) with each year of estrogen-only use and by 0.08 (95% CI, 0.02-0.16) with each year of estrogen-progestin–only use among recent users, after adjustment for mammographic screening, age at menopause, body mass index (BMI), education, and age. The P value associated with the test of homogeneity of these estimates was .02. Among women with a BMI of 24.4 kg/m2 or less, increases in RR with each year of estrogen-only use and estrogen-progestin–only use among recent users were 0.03 (95% CI, 0.01-0.06) and 0.12 (95% CI, 0.02-0.25), respectively. These associations were evident for the majority of invasive tumors with ductal histology and regardless of extent of invasive disease. Risk in heavier women did not increase with use of estrogen only or estrogen-progestin only." The confidence intervals include 1.0 (No increased risk) The increased risk is limited to the first 4 years of use. (So was this just the earlier diagnosis of cancer that was going to be found lated in non-users?) Information was obtained by telephone histories and questionnaires. "Information was collected on age at first use and duration of use of female hormones (excluding creams) other than oral contraceptives. Information was not obtained on type of hormone used." What conclusion can be made from this history?!?!? My reading of the paragraphs of how they evaluated and compared the mammogram and clinical breast exams histories - is that "variables" (fudge factors) were created "A similar variable was created..." The following paragraphs seems to me to say there wasn't much of an association: "Among recent users who used progestins for fewer than 15 days per month, the RRs associated with less than 4 and 4 or more years of use of estrogen-progestin only were 1.1 (95% CI, 0.8-1.7) and 1.5 (95% CI, 1.0-2.4), respectively, based on 26 and 22 cases. The median number of days of progestins were used in this group was 10." "There were too few cases who had used progestins for 15 or more days per month (n) to derive stable estimates according to duration of use. A substantial number of cases (n3) were uncertain how many days in the month they had used progestin." As I read the article, I am not convinced of the conclusion that is stated in the outset. This blatant statement about E/P and breast cancer as if it is a certain fact and bradished across the news media really bugs me. Am I out of line? Do I just not get what they are saying? My patients are all calling in and saying "should I quit my hormones?" Confused.
-- Joanne Bulley, MD Keene, NH
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