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Re: Breast CA & HRT/ERT From: jkulkin (jkulkin@mindspring.com) Wed Feb 16 21:17:20 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Paul Prior MD: "Re: Inappropriate Hysterectomies ( Long)" Previous message: Joanne Bulley, MD: "Breast CA & HRT/ERT" Maybe in reply to: Joanne Bulley, MD: "Breast CA & HRT/ERT" Clearly, women's groups and employers are getting into this equation due to the fear of breast cancer and the morbidity from menopausal health issues. Women are now looking at HRT as a short term decision and considering other long term preventive menopausal therapy like SERM's and herbal/natural alternatives. New Fosamax regimen, Evista, and a new bisphosphonate will offer women a larger menu of options. We are beginning to see a crack in the ERT foundation on which we all grew up in residency. If you look at the package insert for Premarin this year and very carefully compare it to last year you will see subtle differences in it indications. One idication, I think it is for treatment of menopause, was eliminated. It's been a few months since I compared them, but there has been a change. While the data is sorted, I think it is important to recognize that only 15% of women are taking ERT and that 50% of those that start therapy stop inside of 1 year. 85% of women are taking nothing-not even calcium. Women's groups and employers are fed up with this data. They are demanding that we find a way to improve preventive therapy. HEDIS will measure menopause councelling this year which will exert some pressure onn clinicians. Expect to see advocacy groups asking managed care organizations for statistics on what percentage of a given physicians elegible patients are taking preventive therapy. Jay "Joanne Bulley, MD" wrote: > Hey, Folks - As I recall someone(s) somewhere(s) is/are doing a study on > HRT for survivors of Breast Ca that is prospective AND randomized. Who > is doing this study and how long before it reaches maturity and analysis > and publishing. If I am not hallucinating, the peeks at the data to see > if "no Harm" is being done has all been favorable. Somehow, I am more > or less of an educated opinion that estrogen is not a carcinogen to the > breast, but if a CA developes, it may grow faster because of the > hormones as breast is a hormonally responsive tissue. If various HRT > were significantly detrimental - it seems we should have already seen > increasing death rates etc but the death rate of breast cancer is > declining - despite our throwing various HRT regimes at women over the > past 30+ years. Early in training the tumor boards were recommending > oophorectomies on premenopausal Br Ca patients, then decided it didn't > make a difference. I realize that discussing and doing Oophorectomies > is coming back in vogue, but does it incontrovertably make a difference? > Like Paul, however, I hope to see critical analyses of this stuff by > those who are better at I at dissecting out the data! > > Joanne B > > At Wed, 16 Feb 2000, Paul Prior MD wrote: > >The sooner the better. There seems to be a sudden flurry of data that > >flies in the face of most everything we've been telling patients for > >years now and I am getting more and more uncomfortable writing HRT > >scripts everyday. > > > >Paul Prior MD > > -- > Joanne Bulley, MD > Keene, NH Next message: Paul Prior MD: "Re: Inappropriate Hysterectomies ( Long)" Previous message: Joanne Bulley, MD: "Breast CA & HRT/ERT" Maybe in reply to: Joanne Bulley, MD: "Breast CA & HRT/ERT"

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