Bioidentical Hormones - U.S. Senate Special Committee on Aging

lood pressure in women taking CEE is
one possible contributor to this effect because
relatively small differences in systolic
blood pressure have been positively
associated with differences in
stroke and cardiovascular disease
ratte.s.`
The WHI esirogen-alone trial provides
strong evidence that CEE reduces
the nsk of hip, clinical vertebral, and
other fractures. These reductions were
of similar magnitude to those observed
in the WHI estrogen plus progestin trial3'
and are consistent with findings from
prior observational studies 5 " 4 and recent
meta-analyses.""
177
The tTend toward a reduction in
breast cancer incidence was unanticipated
and is opposite of that observed
in the WHI estrogen plus progestin trial,
which reported a 24% increased risk.'o
These results also appear contrary to the
preponderance of observational study
results,"' including those from the recent
Million Women Study.' When examining
breast cancer nsk by type of
hormone therapy, most of these studies
have reported a modest increase in
breast cancer risk with estrogen alone
but a greater risk for estrogen plus progestin.
Still others have recently found
little or no effect of estrogen alone on
Figmno 5. Selected Clinical Otcones by Participant Age and Randomiuation Asrsgnment
00. tby Aw. y
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EFFECTS OF POSTMENOPAUSAL ESTROGEN
breast cancer risk." Differences in
breast cancer screening between the
CEE and placebo groups do not explain
the observed breast caticer effects
because the WHI protocol mandated
annual mammography and
clinical breast examinations. The possibility
that diagnostic delay could account
for this reductiots seems remote
because the effect of CEE alone on
breast density is issnimal. Longerterm
effects ofCEE on breast cancer risk
remain uncertain. Extended lollowup,
as is currently planned, and analyses
of breast cancer characteristics similar
to those reported for the estrogets
00 05 I0 5.5 20 2s 30 3s 40 s s5o ss e0
HCrd eDte
CEE mdic&te rpgatad eou.ne esto.g-; Ci, -6nd-nr ieW-W. Dat. - plotted as hurad rWio, -th e-n Dar showing 95% Cls.
02004 Amn-c-r. Mcdsltdir. All rigisgh se-e-ed. (Repsstsdt) t4AM April 1t, 2004-V 3
291, N5.. t1 1709
-ownoa3dn fCrossa, 5 jar-iao -. at Ntiotnat InstietoCf Hith, on April 16, 2007