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Ailments and Diseases
Published in James Sherifi, General Practice Under the NHS, 2023
Distressing symptoms arising from the menopause were managed with hormone replacement therapy (HRT) although not without controversy. The Million Women Study suggested a relationship between HRT and the risk of breast, endometrial, and ovarian cancer, creating huge anxiety in women who now had to balance benefit against risk. HRT use halved in the UK. By the 2010s, such concerns had been reversed.
Lifestyle Factors in Cancer Survivorship
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
The Million Women Study has been gathering detailed information from 1.28 million women aged 50 to 64 years since 1996. Among other lifestyle factors, they examined how much alcohol women drank at the start of the study and again 3 years later. They then correlated this with the 68,775 cancers they subsequently developed over an average of the next 7 years. They found statistically significant increased risks of a number of cancers in those who regularly consumed alcohol.25 Another study indicated that more than one drink a day specifically increased the risk of breast cancer, but up to one drink was not associated with an increased risk. The risk of alcohol appears to be higher if women have a family history of breast disease, especially if they start drinking as a teenager. Men who drank heavily (>50 g of alcohol or four drinks daily) doubled their risk of high-grade prostate cancers compared with other men, although there was no difference in the incidence of low-grade cancers.
Paper 3 Answers
Published in Hayley Dawson, Anna Trigell, EMQs for the nMRCGP® Applied Knowledge Test, 2018
The Million Women Study (Breast cancer and hormone replacement therapy in the Million Women Study. Lancet 2003; 362: 419) has reinforced much of the information obtained in the Women’s Health Initiative study published in the Journal of the American Medical Association in 2002.
The WHO claims estrogens are ‘carcinogenic’: is this true?
Published in Climacteric, 2023
The ‘time-gap’ hypothesis, raised by Jordan [48], implies that long-term estrogen deprivation of at least 5 years may convert breast cancer cells to become vulnerable to estrogen-induced apoptosis. In contrast, earlier exposure of these cells would encourage growth of ER-positive tumor cells, as the cells are still dependent on estrogens to maintain replication. This hypothesis corresponds to clinical studies such as the WHI and the Million Women Study: in the WHI mono-arm, CEE caused a decrease in breast cancer [20]. In the Million Women Study, users had little increase if estrogen was started more than 5 years after menopause (relative risk = 1.05). However, there was a significant increase in breast cancer if it was started directly after menopause (relative risk = 1.43) [54].
Attitude and knowledge for menopause management among health professionals in mainland China
Published in Climacteric, 2020
According to the 2010 population census, China has 160 million women over 50 years old, with 110 million women aged between 40 and 49 years old (http://www.stats.gov.cn). The average life expectancy of Chinese people in 2018 is 77 years; for women in Beijing, life expectancy is around 84.63 years. The general natural menopausal age of Chinese women is around 49 years old, however (http://www.nhc.gov.cn)1. The defining feature of menopause is estrogen deficiency. Long-term lack of estrogen leads to increased risk of metabolic diseases for the elderly, which poses great threats to the health and life quality of menopausal women. Conjugated estrogen was officially put into clinical use in 1942; at one point, the utilization rate of menopause hormone therapy (MHT) among European and American women was as high as 40%2. However, under the influence of the Women’s Health Initiative study3 and the Million Women Study4, the attitudes of doctors and the general public toward MHT have become more negative5,6. The fundamental reason for this decline was media publicity and doctors’ advice; the utilization rate of MHT in Europe and the USA decreased to approximately 10%7–9. The initiation of menopause management (MM) in China lagged behind somewhat. Although the impact of these two studies has been avoided to a certain degree, the utilization rate of MHT in Chinese menopausal women was only 1–3% due to the traditional fear of hormone usage10,11.
HRT and breast cancer: a million women ride again
Published in Climacteric, 2020
J. C. Stevenson, R. D. T. Farmer
So what should we believe in terms of an association between HRT use and increased risk of breast cancer? The publication5 of a large observational study, the Million Women Study (MWS) from an Oxford group of epidemiologists, again with a blaze of accompanying publicity and pre-publication press releases, reported an elevated risk of breast cancer amongst users of HRT irrespective of the formulation (estrogen–progestogen or estrogen alone), the dose, or route of administration. The point estimates were clearly different from those of the WHI randomized clinical trial. The study has been widely criticised on a number of methodological issues6,7, some of which result in some of the findings being of dubious significance. Notwithstanding the limitations of observational studies (irrespective of their size), the MWS investigators claimed that their study indicated that ‘use of HRT by UK women aged 50–64 years in the past decade is estimated to have resulted in an extra 20,000 incident breast cancers…’