Citations 0
November 13, 2002

A Woman Attempting to Discontinue Hormone TherapyA Woman Attempting to Discontinue Hormone Therapy

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2002;288(18):2264-2265. doi:10.1001/jama.288.18.2264

In Reply: Dr Freedman points out that behavioral approaches may be effective for averting hot flashes. Unfortunately, training in the breathing technique that he describes is not widely available. He also correctly points out that reducing ambient temperature and drinking cold liquids may be helpful.

I agree with Dr Kleerekoper's assessment that the patient is benefiting from ERT. This benefit is entirely due to relief of symptoms that she finds very distressing. She is at high risk for breast cancer, with about 5% risk over the next 5 years. She should, if possible, avoid long-term estrogen use because it increases risk for breast cancer.1,2 Kleerekoper asserts that postmenopausal ERT does not increase risk of breast cancer among women with a family history of breast cancer, and refers to a prospective cohort study in which 5100 women with a family history of breast cancer were followed up for approximately 8 years. The age-adjusted rate of developing breast cancer in these women was 61 in 10 000 among those who had used postmenopausal hormones for 5 or more years compared with 46 in 10 000 among those who did not.3 This difference was not statistically significant due to the small number of cancer cases observed, but the estimate of relative risk was about 1.3, suggesting a 30% increased risk of breast cancer among women with a family history of breast cancer who use hormone therapy. This increased risk is exactly the same as observed in unselected postmenopausal women (those with and without a family history) who received HRT for 5 or more years in other observational studies1 and in the randomized WHI study.2 The WHI found that 5 years of estrogen plus progestin therapy increased the risk of breast cancer 30%, and that there was no interaction of treatment effect and family history or Gail score.2 "No interaction" means that the relative increase in risk for breast cancer due to hormone therapy was the same in women with or without a family history and in women with low or high Gail scores.

First Page Preview View Large
First page PDF preview
First page PDF preview