OE Iversen KK, Haukeland Universitetssykehus ” HRT – og cancer/hjerte- karsykdommer ” Emnekurs i Gynekologi 2010.

Presentasjon om: "OE Iversen KK, Haukeland Universitetssykehus ” HRT – og cancer/hjerte- karsykdommer ” Emnekurs i Gynekologi 2010."— Utskrift av presentasjonen:

1 OE Iversen KK, Haukeland Universitetssykehus ” HRT – og cancer/hjerte- karsykdommer ” Emnekurs i Gynekologi 2010

2 Lipidendringer (%) etter menopause

3 LDL hos menn og kvinner etter alder

4 ØSTROGEN - KORONARSYKD. METAANALYSER ØSTROGEN - KORONARSYKD. METAANALYSER RREndep. l Stampfer M –910,56 (0,5-0,6)Ins.+ død l Grady D -920,65 (0,6-0,7)Insidens 0,63 (0,6-0,7)Død l Barrrett-Connor -980,70 (0,6-0,8)Insidens

5 RCT of HRT RISK of Coronary disease Cases RR (95 % CI) l HERS179/1820,99(0,8-2,3) l WHI HRT164/1221,29 (1,02-1,6) l WEST 14/121,20 (0,5-2,5) l TOTAL357/3161,11 (0,96-1,3) l WHI ERT177/1990,91 (0,8-1,1) Beral et al. Lancet Sept. -02

6 RCT of HRT RISK of Stroke Cases RR (95 % CI) l HERS 82/671,23(0,9-1,7) l WHI HRT*127/851,41 (1,07-1,9) l WEST 63/561,10 (0,8-1,6) l TOTAL272/2081,27 (1,06-1,5) l WHI ERT 158/1181,39 (0,97-2,0) Beral et al. Lancet Sept. -02

7 RCT of HRT RISK of Pulmonary embolus/VT Cases RR (95 % CI) l EVTET 3/12,90 (0,3-27) l HERS 11/42,78(0,9-8,7) l WHI HRT* 70/312,13 (1,4-3,3) l WEST 2/21,00 (0,1-7,1) l TOTAL 86/382,16 (1,5-3,2) l WHI ERT* 101/781,33 (0,9-2,1) Beral et al. Lancet Sept. -02

8 Effect of HT on CHD in Postmenopausal Women: Timing of Initiation WHI (CEE+MPA-arm) 0.001.02.03.04.00.51.52.53.5 Manson JE, et al. N Engl J Med. 2003;349:523-534. Years Since Menopause < 10 10 - 19 > 20 0.89 1.22 1.71 Hazard Ratio for CHD

9 HORMONAL TREATMENT AND RISK OF CANCER HORMONAL TREATMENT AND RISK OF CANCER l IS IT INCREASED (RR >1) ? l DO PROGESTINS MODIFY RISK? l IS MORBIDITY AFFECTED? IS IT THE SAME DISEASE? (STAGE, SIZE, GRADE) l IS MORTALITY AFFECTED? l CAN IT BE GIVEN TO CANCER PATIENTS? l Epidemiology: Associations or causations ?

10 RELATIV OG ABSOLUTT RISIKO (eks. ENDOMETRIECANCER) l KVINNER 50-59 ÅR: 0,5/1000 pr.år l ØSTROGENBRUK (- G): RR = 2 l ØSTROGENBRUK:ABS.R.= 1/1000 Stor eller liten økning?

11 ERT/HRT – Colon cancer Metaanalyse av 18 studier*. (Grodstein F, -99) RR (95 % CI) l Colon0,80 (0,7-0,9) l Rectum0,81 (0,7-0,9) l Colorect ”current”0,66 (0,6-0,7) l *13 av 18 viste beskyttelse l 3 med E+G !

12 RCT of HRT RISK of Colorectal cancer Cases RR (95 % CI) l HERS 11/160,69(0,3-1,5) l WHI HRT 45/670,63 (0,4-0,9) l WHI ERT 61/581,08 (0,8-1,6) l TOTAL 56/830,64 (0,5-0,9) Beral et al. Lancet Sept. -02 / JAMA april -04

13 HRT - CANCER COLI MORTALITET RR (95 % CI) l Calle 1995 ”ever”: 0,71 (0,61-0,82) ”current” :0,55 (0,4-0,76) l Persson 1996: 0,70 (0,5-0,9) l Slattery 1999: 0,60 (0,4-0,9) l Paganini-Hill 1999:0,82 (0,4-1,5) l Nanda 1999:0.72 (0,6-0,8)* *Meta-analyse Oei 01

14 Hva har skjedd etter ”collborative study” 1997 (51 studier)? Hva har skjedd etter ”collborative study” 1997 (51 studier)? 10-15 nye obs studier (MWS) Fokus på gestagener 1-2 RCT (WHI, HERS) Lavere doser

15 WHI: Cancer Risk and Mortality ERT (n=10.739) HRT (n=16.608) ERT(n) HRT(n) Incidence l Breast0,77 218 1,26290 l Colon1,08 61 0,63*112 l Endometrium - - 0,83 47 l All cancer0,93 (0,8-1,1) 1,03 (0,9-1,2) l Mortality1,04 (0,9-1,2) 0,98 (0,8-1,2)

16 WHI – ERT 2004

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18 HRT AND CANCER RISK + = INCREASED; - = REDUCED; 0 = NEUTRAL; * UNOPPOSED

19 Mortality Rates in Women Coronary Artery Disease Stroke Lung Cancer Breast Cancer Colon Cancer Endometrial Cancer Age (years) Mortality Rate per 100,000 6500 4500 2500 1600 1200 800 400 0 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ National Center for Health Statistics. 1999:164-167. Klin. WHI HERS Terapistart:

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