I would like to comment on the article by Bartlett and his
colleagues, “What is Newsworthy?” ( BMJ July 13th pp 81-84) linking the
topic to your news item in the same issue entitled “Hormone trial for
disease prevention stopped early” (July 13th page 61). I was on a lecture
tour in North America when the story about the Women’s Health Initiative
broke (JAMA 2002;288:321-33) and was in a unique position to compare the
coverage in the newspapers in the USA, Canada and the UK (the last
courtesy of the BA executive lounge in Vancouver where the papers were two
days late and the plane ninety minutes delayed). Furthermore I had the
advantage of having actually read the paper in preparation for an
interview with a journalist in Toronto.
Without exception all the press, whether broadsheet or tabloid, lead
with the banner headlines that HRT causes a 26% increase in the incidence
of breast cancer and that this was the reason for aborting the trial. Very
few reports translated this into the absolute value of 8 extra cases for
10,000 women years exposure and none mentioned the fact that this was not
a new observation but merely reinforced the findings from previous studies
[1]. Furthermore none of the reports quoted the conclusion in the abstract
that makes no mention of the breast cancer risk: “ ...All-cause mortality
was not affected during the trial....this regimen should not be initiated
or continued for primary prevention of CHD.” In other words “ Small
earthquake in USA- No one dies”!
As predicted at the first clinic on my return three patients had
booked to ask me about this and where rapidly reassured when I explained
that my earlier estimate of risk had to be raised by an extra two cases
per 10,000 women years and reminded that increased incidence does not
imply increased mortality [2].
I hate to think how many lives will be ruined by acute menopausal
symptoms or lives lost through fractured necks of femur as a result of the
media feeding frenzy.
Yours Sincerely,
Michael Baum
[1] Colditz GA,Hankinson SE, Hunter DJ et al The use of estrogens and
progestins and the risk of breast cancer in postmenopausal women.
N Engl J Med. 1995;332: 1589-1593.
[2] Collaborative group on Hormonal factors in Breast Cancer.Breast
Cancer and hormone replacement therapy: collaborative reanalysis of data
from 51 epidemiological studies in 52,705 women with breast cancer and
108,411 without breast cancer.
Lancet 1997; 350:1047-1059
Competing interests:
No competing interests
18 July 2002
Michael Baum
Emeritus Professor of Surgery and visiting Prpf. of medical humanities University College London
Rapid Response:
What is newsworthy and the HRT controversy.
What is newsworthy?
Dear Sir,
I would like to comment on the article by Bartlett and his
colleagues, “What is Newsworthy?” ( BMJ July 13th pp 81-84) linking the
topic to your news item in the same issue entitled “Hormone trial for
disease prevention stopped early” (July 13th page 61). I was on a lecture
tour in North America when the story about the Women’s Health Initiative
broke (JAMA 2002;288:321-33) and was in a unique position to compare the
coverage in the newspapers in the USA, Canada and the UK (the last
courtesy of the BA executive lounge in Vancouver where the papers were two
days late and the plane ninety minutes delayed). Furthermore I had the
advantage of having actually read the paper in preparation for an
interview with a journalist in Toronto.
Without exception all the press, whether broadsheet or tabloid, lead
with the banner headlines that HRT causes a 26% increase in the incidence
of breast cancer and that this was the reason for aborting the trial. Very
few reports translated this into the absolute value of 8 extra cases for
10,000 women years exposure and none mentioned the fact that this was not
a new observation but merely reinforced the findings from previous studies
[1]. Furthermore none of the reports quoted the conclusion in the abstract
that makes no mention of the breast cancer risk: “ ...All-cause mortality
was not affected during the trial....this regimen should not be initiated
or continued for primary prevention of CHD.” In other words “ Small
earthquake in USA- No one dies”!
As predicted at the first clinic on my return three patients had
booked to ask me about this and where rapidly reassured when I explained
that my earlier estimate of risk had to be raised by an extra two cases
per 10,000 women years and reminded that increased incidence does not
imply increased mortality [2].
I hate to think how many lives will be ruined by acute menopausal
symptoms or lives lost through fractured necks of femur as a result of the
media feeding frenzy.
Yours Sincerely,
Michael Baum
[1] Colditz GA,Hankinson SE, Hunter DJ et al The use of estrogens and
progestins and the risk of breast cancer in postmenopausal women.
N Engl J Med. 1995;332: 1589-1593.
[2] Collaborative group on Hormonal factors in Breast Cancer.Breast
Cancer and hormone replacement therapy: collaborative reanalysis of data
from 51 epidemiological studies in 52,705 women with breast cancer and
108,411 without breast cancer.
Lancet 1997; 350:1047-1059
Competing interests: No competing interests