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BMJ 2009; 339 doi: (Published 20 July 2009) Cite this as: BMJ 2009;339:b2918

Study confirms link between hormone therapy and ovarian cancer

Women who take hormone replacement therapy have an increased risk of ovarian cancer—about one extra cancer for every 8300 women using hormones for one year, according to a large observational study from Denmark.

The study cohort included nearly one million women who were at least 50 years old when the study started in 1995. After eight years of follow-up, 3068 women had developed an ovarian cancer, mostly epithelial. Current use of any formulation of hormone therapy by any route was associated with a relative risk of 1.38 (95% confidence interval 1.26 to 1.51) for ovarian cancer compared with women who had never used hormones. The authors looked separately at oestrogen only therapy, and combined therapy with oestrogen and progestin. They also considered oral, transdermal, vaginal, continuous, and cyclical regimes. All were associated with an increased risk of ovarian cancer, with little to choose between them. The excess risk lasted for about two years after the end of treatment.

If the association is causal, hormone therapy was responsible for 140 cases of ovarian cancer in the whole of Denmark during these eight years, say the authors. The excess risk is small in real terms but should still be factored in to decisions about hormone therapy.

Capsule endoscopy of the large bowel seems less reliable than colonoscopy

Ingestible cameras developed to visualise the inside of the small bowel have recently been adapted to examine the colon. When manufacturers Given Imaging tested their capsule endoscope PillCam COLON against traditional colonoscopy, they found that the capsule endoscope picked up 64% (95% CI 59% to 72%) of the larger polyps, 73% (61% to 83%) of the advanced adenomas, and 74% (52% to 88%) of the 19 cancers detected by colonoscopy. Specificities were 84% (81% to 87%) for polyps measuring at least 6 mm and 79% (77% to 81%) for advanced adenomas.

The study included 320 …

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