Hormone Replacement Therapy Nonusers Research Articles

Exercício aeróbico no controle da hipertensão arterial na pós-menopausa

OBJETIVO: Avaliar o efeito do treinamento com exercício aeróbio na capacidade funcional (CF) e no controle da pressão arterial (PA), em mulheres na pós-menopausa, hipertensas estágio I, controladas ou não com tratamento medicamentoso, em uma Unidade Básica de Saúde (UBS). METODOLOGIA: Antes e após 12 semanas de treinamento com exercício aeróbio em uma UBS, dez mulheres hipertensas na pós-menopausa, idade de 56,9 ± 6 anos, sedentárias, não usuárias de terapia de reposição hormonal, foram submetidas à avaliação do índice de massa corporal (IMC); da circunferência da cintura (CC); da CF pelo teste ergométrico (maior consumo de oxigênio/ VO2 e tempo de teste) e teste de caminhada em seis minutos (distância caminhada); e das medidas casuais repetidas da PA. Reavaliações foram efetuadas a cada 30 dias. Os dados são expressos em média e desvio-padrão. Foram aplicados os testes de Kolmogorov-Smirnov, t de Student pareado, Wilcoxon e ANOVA para medidas repetidas, considerando significativo p < 0,05. RESULTADOS: Não houve diferença significativa no IMC (p = 0,40) e CC (p = 0,74) após a intervenção. Entretanto, após 30 dias observou-se redução da PA sistólica (de 142,70 ± 6,25 para 130,76 ± 5,80 mmHg, p < 0,001) e diastólica (de 87,03 ± 4,48 para 81,90 ± 4,30 mmHg, p = 0,002) e melhora da CF pelo VO2 (de 24,90 ± 6,38 para 27,82 ± 6,14 mL/kg/min, p = 0,028), tempo de teste (de 6,89 ± 1,78 para 7,7 ± 1,8 min, p = 0,022) e distância caminhada (de 511,07 ± 41,99 para 556,1 ± 43,19 m, p = 0,009). CONCLUSÃO: O programa de treinamento com exercício aeróbio em uma UBS mostrou-se efetivo e viável, contribuindo para a redução da PA e melhora da capacidade funcional em mulheres hipertensas na pós-menopausa.

The Effect of Prothrombotic Blood Abnormalities on Risk of Deep Vein Thrombosis in Users of Hormone Replacement Therapy

Few studies have assessed the effect of prothrombotic blood abnormalities on the risk of deep vein thrombosis (DVT) with hormone replacement therapy (HRT). We studied postmenopausal women with suspected DVT in whom HRT use and prothrombotic blood abnormalities were sought. Cases had unprovoked DVT and controls had no DVT and without DVT risk factors. The risk of DVT was determined in women with and without prothrombotic abnormalities. A total of 510 postmenopausal women with suspected DVT were assessed; 57 cases and 283 controls were identified. Compared to HRT, nonusers without the factor V Leiden mutation, the risk of DVT was increased in estrogen-progestin HRT users (odds ratio [OR], 3.2; 95% confidence interval [CI]: 1.2-8.6) and in nonusers with the factor V Leiden mutation (OR, 5.3; 1.9-15.4) and appears multiplied in users of estrogen-progestin HRT with the factor V Leiden mutation (OR, 17.1; 3.7-78). Compared to HRT, nonusers with normal factor VIII, the risk of DVT was increased in estrogen-progestin HRT users with normal factor VIII (OR, 2.8; 1.0-7.9) and in HRT nonusers with the highest factor VIII quartile (OR, 6.0; 2.1-17), and appears to be multiplied in women who are users of estrogen-progestin HRT with the highest factor VIII quartile (OR, 17.0; 3.6-80). In postmenopausal women who are estrogen-progestin HRT users, the presence of the factor V Leiden mutation or an elevated factor VIII level appears to have a multiplicative effect on their overall risk of DVT, increasing it 17-fold compared to women without these blood abnormalities who are HRT nonusers.

Prognostic effects of 25-hydroxyvitamin D serum concentrations in postmenopausal breast cancer

Background: Vitamin D has been inconsistently associated with breast cancer risk. Thus far, only one study has investigated its association with mortality after breast cancer diagnosis. We examined post-diagnostic serum concentrations of 25-hydroxyvitamin D [25(OH)D] in relation to all-cause mortality in postmenopausal breast cancer patients. Methods: Incident breast cancer patients aged 50–74 years were diagnosed between August 2002 and July 2005 and part of a population-based case-control study conducted in Germany (MARIE). Vital status was ascertained via local population registries up to the end of 2009, and deaths were verified by death certificates. For this analysis, we included 1,369 postmenopausal primary breast cancer cases with serum concentrations of 25(OH)D measured after diagnosis (median 83 days) and with information on tumor stage and personal history of other cancers. Cox proportional hazards regression stratified by age at diagnosis and season of blood draw was used to estimate univariate and multivariate risks of all-cause mortality. Results: Median follow-up time was 5.8 years (range 0.3 to 7.4 years), and 196 women died. Compared with the lowest category (<30 nmol/L), univariate hazard ratios (HR) and 95% confidence intervals (CI) for the higher categories of 25(OH)D serum concentrations (30–45, 45–60, 60–75 and ≥75 nmol/L) were 0.48 (0.32–0.71), 0.40 (0.26–0.63), 0.42 (0.25–0.70), and 0.38 (0.22–0.66), respectively (p-trend=0.0002). The association remained after multivariate adjustment for tumor stage, personal history of other cancers and diabetes, i.e. 0.60 (0.39–0.92), 0.55 (0.34–0.90), 0.50 (0.28–0.88), and 0.51 (0.28–0.93), respectively (p-trend=0.01). Further adjustment for therapy, ER/PR status, and several lifestyle factors did not substantially change the risk estimates. Associations were only statistically significant for women with blood drawn within 83 days of diagnosis (p-interaction <0.01) and for non-users of hormone replacement therapy (p-interaction <0.01). Conclusion: Higher serum 25(OH)D concentrations may be associated with improved overall survival in postmenopausal breast cancer patients.

Risk of hypoactive sexual desire disorder and associated factors in a cohort of oophorectomized women

Background Women with surgical menopause are at high risk of developing hypoactive sexual desire disorder (HSDD), which may cause sexual and emotional discomfort.Aim To determine the prevalence of HSDD and related risk factors in Spanish surgically postmenopausal women.Design Multicenter, cross-sectional study.Material and methods The Brief Profile of Female Sexual Function© (B-PFSF©) questionnaire was given to 1136 surgically postmenopausal women between 18 and 81 years old (mean 52.1 ± 7.1 years) attending gynecological consultations in different urban and rural areas in Spain, covering the country widely.Results From the entire sample, 1083 subjects were finally included. The mean score on the B-PFSF© was 15.9 and a total of 74.4% of the patients presented total scores lower or equal to 20, indicating the risk of presenting with HSDD. The possibility to be at risk of HSDD increased with age from 65.9% in the age group <45 years old to 76.6% in the age group ≥55 years old. Non-users of hormone replacement therapy presented a higher risk of HSDD (odds ratio 2.1; 95% confidence interval 1.3–3.4); the risk was increased as well when the time elapsed since surgical menopause was <5 years (odds ratio 1.8; 95% confidence interval 1.0–3.0).Conclusion Nearly three out of four women who had undergone bilateral oophorectomy were at risk of suffering HSDD; this risk was increased when less than 5 years since surgical menopause had elapsed. The use of hormone replacement therapy was associated with lower HSDD risk.

Hormone Replacement Therapy and the Increase in the Incidence of Invasive Lobular Cancer

Individual epidemiologic studies and a meta-analysis of those studies suggest that the relative risk of invasive lobular and compared to invasive ductal cancer is particularly affected by combined hormone replacement therapy (HRT) in postmenopausal women, with an approximate doubling of risk of invasive lobular breast cancer in current users. However, this was not seen in the Women's Health Initiative trial comparing combined HRT and placebo, although this trial had only modest statistical power to demonstrate the effect. In the absence of some obvious source of bias (screening mammography rates were well balanced between HRT users and non-users in most studies), this evidence supports the hypothesis that combined HRT increases the risk of lobular breast cancer.

Obesity and poor breast cancer prognosis: an illusion because of hormone replacement therapy?

High body mass index (BMI) and use of hormone replacement therapy (HRT) increase the risk of postmenopausal breast cancer. It has been shown that BMI modifies the effect of HRT, as its influence is most pronounced in lean women. We investigated the influence of BMI and HRT on prognosis in 2640 postmenopausal women diagnosed with breast cancer in Sweden in 1993–1995, taking into account HRT and mammography before diagnosis. Logistic and Cox regression were used. In non-users of HRT, obese women (BMI >30) compared with normal weight women (BMI <25) had a similar prognosis (hazard ratio (HR) 1.1, 95% confidence interval (CI) 0.8–1.6), despite larger tumours found in obese women. Obese HRT users had less favourable tumour characteristics and poorer prognosis compared with normal weight women (HR 3.7, 95% CI 1.9–7.2). The influence of BMI on breast cancer prognosis was similar whether diagnosed by mammographic screening or not. We found a similar prognosis of postmenopausal breast cancer-specific death regardless of BMI in non-users of HRT, but among HRT users obesity was associated with a poorer breast cancer prognosis.

Physical activity and mammographic breast density in a Mediterranean population: The EPIC Florence longitudinal study

A protective effect of physical activity (PA) on breast cancer (BC) risk has been suggested. Few studies have examined the influence of PA on mammographic breast density (MBD), a strong risk factor for BC. In a prospective study in Florence, Italy, we identified 2,000 healthy women with a mammogram taken 5 years after enrollment. Individual mammograms were retrieved (83%) and MBD assessed according to Wolfe's classification. Detailed information on PA at work and during leisure time, reproductive history, lifestyle and anthropometric measurements at enrollment were available for 1,666 women. Information on hormone replacement therapy (HRT) was also obtained at mammogram. Women with high-MBD (P2 + DY Wolfe's patterns) were compared with women with low-MBD (N1 + P1) by multivariate logistic models. Overall, high-MBD was inversely associated with increasing levels of leisure time PA (p for trend = 0.04) and among peri-/postmenopausal women, also with increasing levels of recreational activities (p for trend = 0.02). An interaction between PA and HRT emerged, with a stronger inverse association of highest level of recreational activity with MBD among HRT nonusers (p for interaction = 0.02). A modifying effect by body mass index (BMI) was evident among 1,025 peri-/postmenopausal women who did not use HRT at the time of mammogram, with a stronger inverse association between recreational PA and MBD in the highest BMI tertile (OR = 0.34; 95% CI 0.20-0.57; p for interaction = 0.03). This large study carried out in Mediterranean women suggests that leisure time PA may play a role in modulating MBD, particularly in overweight/obese peri-/postmenopausal women.

Change in the use of hormone replacement therapy and the incidence of fracture in Oslo

Fracture incidence in Oslo decreased from the 1970s to the 1990s in younger postmenopausal women, but not in older women or in men. Concurrently, hormone replacement therapy increased considerably. Using data from the Oslo Health Study, we estimated that roughly half the decline might be attributed hormone replacement therapy. Between the late 1970s and the late 1990s, the incidence of hip fracture and distal forearm fracture decreased in younger postmenopausal women in Oslo, but not in elderly women or in men. The purpose of this report is to evaluate whether the decreased incidence was coherent with trends in use of hormone replacement therapy (HRT). Data on estrogens were collected from official drug statistics, data on fractures from published studies and data on bone mineral density (BMD) from the Oslo Health Study. The sale of all estrogens increased 22 times from 1979 to 1999, and the sub-category estradiol combined with progestin increased 35 times. In the corresponding period the incidence of distal forearm fracture in women aged 50-64 years decreased by 33% and hip fracture by 39%. Based on differences in BMD between users and non-users of HRT, we estimated that up to half of this decline might be due to HRT. The reduction in fracture incidence in postmenopausal women in Oslo occurred in a period with a substantial increase in the use of HRT. Future surveillance will reveal whether the last years' decline in use of HRT will be translated into increasing fracture rates.

Life prevalence of hormone replacement therapy and profile of users have not changed among women with self-reported menopause in the last two decades in Porto, Portugal

Objectives To describe the prevalence of hormone replacement therapy (HRT) in a Portuguese population by menopause date, from 1985 to 2005.Methods Participants were 382 postmenopausal women assessed as part of the ongoing follow-up evaluation of a cohort of Portuguese adults. Data were collected on education, lifetime use of oral contraceptives, menopause status, spontaneous or surgical menopause, and lifetime use of HRT. HRT use was analysed yearly and across 5-year menopause intervals, from 1985 to 2005.Results Overall, 40.1% of women who entered menopause between 1985 and 2005 reported having ever used HRT. No significant trend was observed throughout the 20-year period or across the 5-year intervals. Additionally, no trend was observed in HRT prevalence among women who either reported surgical or spontaneous menopause. Median education increased significantly among both HRT users and non-users; however, from 1990 onwards, HRT users were significantly more educated than non-users.Conclusions The prevalence of use of HRT and characteristics of users among Portuguese women living in Porto and entering menopause in the last 20 years have not changed substantially.

Hormone replacement therapy, body mass, and the risk of colorectal cancer among postmenopausal women from Germany

Previous studies have reported inconsistent results regarding the modifying effect of hormone replacement therapy (HRT) on the association of body mass index (BMI) and the risk of colorectal cancer (CRC) among postmenopausal women. We assessed the use of HRT and BMI in 208 postmenopausal women with histologically confirmed incident CRC and 246 controls in a population-based case–control study in Germany (DACHS study). Ever use of HRT was strongly associated with reduction of CRC risk (adjusted odds ratio 0.41, 95% confidence interval 0.25–0.67). Among nonusers of HRT, risk of CRC was strongly increased in women with BMI 27 to <30 kg m−2 (2.76, 1.07–7.12) and obese women (3.30, 1.25–8.72), when compared with women with BMI <23 kg m−2 (P for trend <0.01). BMI was not associated with risk of CRC among HRT users (P for interaction <0.01). In contrast to most other studies, a positive association of BMI and CRC risk was found among nonusers of HRT, but not among users of HRT. The reasons for the inconsistency of results regarding the potential risk modifying effect of postmenopausal hormones in the association of BMI with CRC remain inconclusive and require further study.

Systemic Lupus Erythematosus in a Multiethnic US Cohort (LUMINA L II)

To examine the influence of hormone replacement therapy (HRT) in the occurrence of vascular arterial and venous thrombotic events in postmenopausal women with systemic lupus erythematosus (SLE). SLE women aged > or =16 years, disease duration < or =5 years from LUMINA, a multiethnic, longitudinal outcome study, were included. Menopause was defined at disease onset as the presence of amenorrhea >6 months and/or oophorectomy, and/or increased follicle stimulating hormone values, and/or HRT use regardless of the presence or absence of climacteric symptoms (hot flashes). Patients were divided into HRT ever users and nonusers. Patients with positive antiphospholipid antibodies (n = 9) or vascular arterial events (n = 1) occurring before HRT use were excluded. The occurrence of vascular arterial and venous thrombotic events was compared between HRT users and HRT nonusers and its role examined by logistic regression after adjusting for "confounding by indication" using propensity score or logistic regression analyses. Seventy-two postmenopausal women, 32 (44%) HRT users and 40 (56%) HRT nonusers, were studied. HRT use was associated with fewer vascular arterial but not venous thrombotic events (P = 0.021) in the univariable analyses. However, after adjusting for the propensity score, HRT use was no longer significant (P = 0.064). Comparable results were obtained by logistic regression. HRT use was not associated with the occurrence of vascular arterial events in the LUMINA patients. HRT use in women with SLE should be individualized, but our data suggest its use may be safe if antiphospholipid antibodies are not present or vascular arterial events have not previously occurred.

Continuous combined hormone replacement therapy relieves climacteric symptoms and improves health-related quality of life in early postmenopausal women

Hormone replacement therapy (HRT) relieves menopausal symptoms but its effect on health related quality of life (HRQoL) is uncertain. The aim of this study was to assess the effect of three dose regimens of continuous combined HRT, consisting of estradiol valerate (E2V) and medroxyprogesterone acetate (MPA) on HRQoL in early postmenopausal women (last menstrual period 1-3 years before study entry). This was a 52-week, randomized, double-blind, multinational study comparing E2V (1 mg or 2 mg) plus MPA (2.5 mg or 5 mg) in different dose combinations. The intention-to-treat population comprised 459 women (average age 51.5 years). HRQoL was assessed by the Women's Health Questionnaire (WHQ), the 15D Questionnaire and a visual analogue scale (VAS). There were improvements on eight of the nine domains of the WHQ with all dose regimens during the first 12 weeks (P<0.0001) and an improvement in the remaining domain (menstrual symptoms) with the lower-dose regimens (P<0.05). These initial improvements in HRQoL were then maintained or augmented over the remainder of the study (P<0.0001 for change from baseline at 52 weeks for all domains and dose regimens). Mean 15D total score had improved meaningfully and significantly by 12 weeks (P<0.0001 versus baseline) in all treatment groups and this improvement was maintained thereafter. This improvement in 15D total score was most marked among previous non-users of HRT (P<0.05 versus previous users). VAS scores recorded significant (P<0.05) reductions in hot flushes, sweating and sleep disturbances in all groups after week 1 and highly significant (P<0.0001) relief of all climacteric symptoms at week 52. Continuous combined HRT was associated with pronounced improvement of vasomotor symptoms and HRQoL in this population of early postmenopausal women.

The effect of hormone replacement therapy on cognitive function in post-menopausal women

Despite interest in causes of dementia in older persons, particularly in post-menopausal women, it is unclear whether hormone replacement therapy (HRT) is a risk factor. To assess cognitive function in post-menopausal women with high educational status receiving HRT, compared to non-users. Cognitive functioning was assessed with in women aged 55-60 years with at least university-level education, using the Mindstreams system, a computerized cognitive battery with multiple domains. Of 165 women meeting the inclusion/exclusion criteria, 82 women (49.7%) declined participation. Of the remaining 83, 40 (48.2%) had never received HRT; the remainder was divided into women receiving 5-9 years HRT (n = 29)versus those with >or=10 years HRT (n = 11). There were no statistically significant differences between HRT users and non-users in global scores or sub-domains of cognitive functioning, and no difference between those women receiving HRT for 5-9 years vs. >or=10 years. Long-term HRT does not appear to impair cognitive functioning in highly-educated women. Recommendations regarding post-menopausal HRT should be made on an individual basis.

Sizing up the association between body fat and colorectal cancer risk

Sizing up the association between body fat and colorectal cancer risk

Presurgical promestriene therapy in postmenopausal women with stress urinary incontinence

Objective. Our study was aimed at evaluating the efficacy of therapy with promestriene, a synthetic diethyl-ether of estradiol with no distal hormonal effects, in patients undergoing surgical correction for stress urinary incontinence (SUI).Materials and methods. Ninety-eight healthy, postmenopausal women, non-users of hormone replacement therapy, with a diagnosis of SUI and vulvovaginal dystrophy, were recruited and openly randomized into two main groups. Group I (48 patients) received promestriene 10 mg daily, by vaginal capsule, for 21 days before the operation. Group II (50 patients) underwent the surgical procedure with TVT (Tension-free Vaginal Tape) directly, without pharmacological preparation. The results were collected and analyzed using SAS software (version 8).Results. The two groups were homogeneous in terms of age, parity and body mass index. There were no significant differences between the two groups with respect to the time required to accomplish the TVT, blood loss, length of hospital stay, blood component measurements and postoperative subjective symptoms. There were slight differences postoperatively in problems during intercourse and the appearance of new genital symptoms, but again they were not shown to be statistically significant.Conclusions. Our results, although preliminary and subjective, confirm the efficacy of remedial surgical treatment of SUI with TVT. Preoperative administration of promestriene seems to favor trophism and vascularization of the whole muscular and fascial support of the pelvic floor and facilitates performance of the operation, but is not supported statistically.

The Impact of Hormone Replacement Therapy on Menopausal Symptoms in Younger High-Risk Women After Prophylactic Salpingo-Oophorectomy

Preventive health strategies for women at increased hereditary risk of ovarian cancer include gynecologic screening (GS) and/or prophylactic oophorectomy (PBSO). Hormone replacement therapy (HRT) is often prescribed to compensate for postsurgical endocrine deficiencies. This study examined the impact of HRT use on levels of endocrine symptoms and sexual functioning among premenopausal women who have undergone PBSO. Comparisons were made with similar women undergoing GS. Questionnaire data on endocrine symptoms and sexual functioning were obtained from 450 premenopausal, high-risk women who had participated in this nationwide, cross-sectional, observational study. Thirty-six percent of women had undergone PBSO and 64% had opted for GS. In the PBSO group, 47% of the women were current HRT users. They reported significantly fewer vasomotor symptoms than nonusers (P < .05). However, compared with premenopausal women undergoing GS, oophorectomized HRT users were more likely to report vasomotor symptoms (P < .01). HRT users and nonusers reported comparable levels of sexual functioning. Compared with women in the GS group, oophorectomized HRT users reported significantly more sexual discomfort due to vaginal dryness and dyspareunia (P < .01). Although HRT has a positive impact on surgically induced vasomotor symptoms, it may be less effective than is often assumed. Symptom levels remain well above those of premenopausal women undergoing screening, and sexual discomfort is not alleviated by HRT. Physicians need to provide younger high-risk women considering PBSO with realistic information about both benefits and drawbacks of this preventive strategy, including information about premature menopause and HRT.

Hormone replacement therapy and mammographic screening outcomes in Western Australia

The study objectives were three-fold: to estimate the effect of hormone replacement therapy (HRT) use on the sensitivity of mammographic screening; to examine the odds of having an interval cancer as a function of duration of HRT use and to compare the size, grade, lymph node and hormone receptor status of tumours for HRT users and non-users. Perth, Western Australia, where a free, population-based mammographic screening service targets women aged 50-69 years. The cohort consisted of 113,310 women who had 119,296 screening episodes between January 1998 and December 1999. Unconditional logistic regression was used to model the odds of having an interval cancer as a function of the effect of the duration of HRT use (measured in years). Using subsequent screening rounds, chi2-tests were used to examine whether HRT users differed from HRT non-users in terms of tumour characteristics. Ninety-seven screen-detected and 31 interval cancers were diagnosed among women who were on initial screening rounds, and 393 screen-detected and 153 interval cancers were diagnosed among women on subsequent screens, two years post screening. Two-year sensitivity outcomes were significantly lower for HRT users on initial screening rounds. For women on subsequent screening rounds, the odds of having an interval cancer increased with the duration of HRT use (odds ratio 1.09, 95% confidence interval 1.04-1.14, P<0.04) after controlling for age, family history, tumour grade, size and pathology type. The histopathological characteristics of cancers did not differ for HRT users compared with HRT non-users. The sensitivity of mammographic screening was reduced and the odds of having an interval cancer were increased for HRT users compared with HRT non-users. For women on subsequent screening episodes, the odds of having an interval cancer increased with duration of HRT use.

Estrogen Prevents Cardiomyocyte Apoptosis through Inhibition of Reactive Oxygen Species and Differential Regulation of p38 Kinase Isoforms

From human and animal studies, estrogen is known to protect the myocardium from an ischemic insult. However, there is limited knowledge regarding mechanisms by which estrogen directly protects cardiomyocytes. In this report, we employed an in vitro model, in which cultured rat cardiomyocytes underwent prolonged hypoxia followed by reoxygenation (H/R), to study the cardioprotective mechanism of estrogen. 17-beta-estradiol (E2) acting via estrogen receptors inhibited H/R-induced apoptosis of cardiomyocytes. Mitochondrial reactive oxygen species (ROS) generated from H/R activated p38alpha MAPK, and inhibition of p38alpha with SB203580 significantly prevented H/R-induced cell death. E2 suppressed ROS formation and p38alpha activation by H/R and concomitantly augmented the activity of p38beta. Unlike p38alpha, p38beta was little affected by H/R. Dominant negative p38beta protein expression decreased E2-mediated cardiomyocyte survival and ROS suppression during H/R stress. The prosurvival signaling molecule, phosphoinositol-3 kinase (PI3K), has previously been linked to cell survival following ischemia-reperfusion injury. Here, E2-activated PI3K was found to inhibit ROS generated from H/R injury, leading to inhibition of downstream p38alpha. We further linked these signaling pathways in that p38beta was activated by E2 stimulation of PI3K. Thus, E2 differentially modulated two major isoforms of p38, leading to cardiomyocyte survival. This was achieved by signaling through PI3K, integrating cell survival mediators.

Influence of Hormone Replacement Therapy on the Accuracy of Screening Mammography

The use of hormone replacement therapy (HRT) is currently a subject of debate because of the possibility of an increase in the incidence of breast cancer and difficulties associated with breast cancer detection. The objective of this study was to determine the influence of HRT on specificity and sensitivity in a breast cancer screening program. We found that although specificity was significantly lower in menopausal women who had ever used or were currently using HRT (93.3%) compared to HRT nonusers (94.8%) at the expense of a greater number of recalls (6.9% versus 5.6%), this difference seems to be clinically irrelevant. There were no significant differences with regard to the number of invasive procedures (2.5% in the HRT versus 2.1% in the control group). We conclude that the slight decrease in sensitivity of screening mammography in HRT users is not clinically significant in our setting, and in any case, false positives (recalled women) are diagnosed correctly with additional imaging studies without the need for invasive procedures. Most women given HRT are candidates to participate in population breast cancer screening campaigns.

Hormone replacement therapy and mortality in 52- to 70-year-old women: the Kuopio Osteoporosis Risk Factor and Prevention Study

To analyze prospectively the association between hormone replacement therapy (HRT) and mortality in women before old age. A group of 11,667 women (91% of the age cohort of the area) aged 52-62 years from the population-based Kuopio Osteoporosis Risk Factor and Prevention Study were followed for 7 years in 1994-2001. Information about HRT use and health events was obtained from two repeated questionnaires in 1989 and 1994. Information about deaths and causes of death from the follow-up period was obtained from the Statistics Finland. Cox's proportional-hazards models were used to calculate risk of death related to the use of HRT. At the start of follow-up, 2203 women had used HRT > 5 years, 3945 women < or = 5 years and 5519 women had never used it. During the follow-up, 361 deaths occurred. Compared with non-users of HRT, the adjusted hazard ratio (HR) of death from any cause was 1.05 (95% confidence interval (CI) 0.80-1.36) in women who used HRT < or = 5 years and 1.06 (95% CI 0.78-1.46) in women who used HRT > 5 years. The adjusted HR for coronary heart disease (CHD) mortality in women who used HRT < or = 5 years was 0.79 (95% CI 0.36-1.73), and in women who used HRT > 5 years, 2.16 (95% CI 0.93-4.98). For breast cancer mortality the adjusted HR for < or = 5 years of HRT use was 0.96 (95% CI 0.32-2.82) and 2.62 (95% CI 0.98-7.00) for > 5 years of HRT use. History of HRT use does not affect overall or CHD mortality in women. More than 5 years of HRT use may increase the risk of breast cancer mortality.