No overall increase in all cause mortality with HRT, study finds
BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j4230 (Published 12 September 2017) Cite this as: BMJ 2017;358:j4230
All rapid responses
Epidemiological studies can seriously mislead if epidemiologists do not have clean never users of hormones for controls. Their resulting data can encourage false claims of benefit or no effect .1
How many deaths would there been if the Women's Health Initiative Studies, of either combined progestogen HRT or estrogen only HRT, had not been terminated prematurely? This was because of unacceptable increases in cancers and vascular diseases? Most women enrolled had previously used progestogens and oestrogens for either contraception or therapy but nevertheless, the WHI epidemiologists randomly divided the women into Takers or Never takers.
In reality, the world-wide fall in hormone use after the early WHI terminations resulted in decreases in breast and ovarian cancer incidence and mortality. 2-5
Use of HRT progestogens and oestrogens quickly increases the main causes of death. It is a shame to encourage use of carcinogenic, vasoactive, psychoactive and immune modulating hormones merely to suppress vasomotor symptoms. As a clinician, I have found avoiding smoking and alcohol, low allergy high protein diets, repletion of essential nutrients to be safe and basic .6,7 There are more details in my lectures at www.harmfromhormones.co.uk
1 No overall increase in all cause mortality with HRT, study finds. BMJ 2017;358:j4230
2 Grant ECG. Reduction in mortality from breast cancer: fall in use of hormones could have reduced breast cancer mortality. BMJ. 2005 Apr 30;330(7498):1024.
3 Colditz GA. Decline in breast cancer incidence due to removal of promoter: combination estrogen plus progestin. Breast Cancer Res. 2007;9:108.
4 Ravdin M, Cronin KA, Howlander N, Berg CD, Chlebowski RT, Feuer EJ, Edwards BK, Berry DA. The Decrease in Breast Cancer Incidence in 2003 in the United States.NEJM. Vol. 356, No.16. April 19, 2007
5 Grant Ellen C G. Endometrial cancer with progestagen and oestrogen oral contraceptives. The Lancet Oncology, 2015;16: 15,e527
6 Grant ECG. Food allergies and migraine. Lancet 1979;1:966-6.
7 Grant ECG. The pill, hormone replacement therapy, vascular and mood over-reactivity , and mineral imbalance .J Nutr Environ Med 1998;8:105-116.
Competing interests: No competing interests
If all hysterectomies and bilateral oophorectomies were followed by long term hormone replacement therapies, no increased cardiovascular mortality trends would have been detected. [2][3]
Those women were simly abandoned during their post-operative period.
Unrealistic fears [1] deprived them from vital therapeutic interventions.
References
[1] http://jamanetwork.com/journals/jama/article-abstract/2653735
[2] http://www.bmj.com/content/356/bmj.j372
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4254662/
Competing interests: No competing interests
HRT and breast cancer screening - one law for one, another for the other?
In their independent review of breast cancer screening Marmot et al estimate that the trials to date are not of sufficient size to calculate any change in all cause mortality. Nevertheless, they conclude by recommending the continuation of the current breast cancer screening programme.
Meanwhile, Jacqui Wise has reported the results of an 18 year followup study of HRT indicating that there is no increase in all-cause mortality. The authors of this study conclude by recommending the use of HRT where clinically indicated.
Could someone cleverer than me please explain why apparently similar results have led to opposite conclusions? It seems to me to be surprising that a screening programme costing over £100 million per year is continuing in the absence of evidence of any reduction of all-cause mortality.
"In particular, a 20% RR reduction in breast cancer deaths for ages 55–79 years would yield only 3.0% and 1.2% RR reductions in all-cancer and all-cause deaths, respectively. The trials are not of sufficient size (in terms of numbers of women and length of follow-up) to allow such small RR reductions to be reliably estimated. Hence, a statistically non-significant effect for all-cancer or all-cause deaths in the trials cannot be interpreted as evidence against a reduction in breast cancer deaths."
Independent UK Panel on Breast Cancer Screening. The benefits and harms of breast cancer screening: an independent review. Lancet 2012;380:1778-86.
http://dx.doi.org/10.1001/jama.2017.11217
https://doi.org/10.1136/bmj.j4230
Competing interests: No competing interests