Patient-specific decisions about hormone replacement therapy in postmenopausal women
Abstract
Objective To examine the effect of hormone replacement therapy on life expectancy in postmenopausal women with different risk profiles for heart disease, breast cancer, and hip fracture. Design Decision analysis using a Markov model. Published regression models were used to link risk factors to disease incidence and to estimate the lifetime risks of developing coronary heart disease (CHD), breast cancer, hip fracture, and endometrial cancer. The impact of hormone therapy on disease incidence was estimated from published epidemiologic studies. Setting Mathematical model applicable to primary care. Interventions Treatment with hormone replacement therapy or no hormone replacement therapy. Main outcome measure Life expectancy. Results Hormone replacement therapy should increase life expectancy for nearly all postmenopausal women, with some gains exceeding 3 years, depending mainly on an individual's risk factors for CHD and breast cancer. For women with at least 1 risk factor for CHD, hormone therapy should extend life expectancy, even for women having first-degree relatives with breast cancer. Women without any risk factors for CHD or hip fracture, but who have 2 first-degree relatives with breast cancer, however, should not receive hormone therapy. Conclusions The benefit of hormone replacement therapy in reducing the likelihood of developing CHD appears to outweigh the risk of breast cancer for nearly all women in whom this treatment might be considered. Our analysis supports…
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STMs used to evaluate primary prevention strategies are concerned with reduction in the risk of developing a disease.
“STMs used to evaluate primary prevention strategies are concerned with reduction in the risk of developing a disease (e.g., [15]).”
From State-Transition Modeling: A Report of the ISPOR-SMDM Modeling Good Research Practices Task Force-3 (2012) · cites this paper as [15]
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- Authors
- Col, N. F.
- Affiliations
- Tufts University (US)
- Corresponding author
- Col, Nananda F.
- ORCID
- Col, Nananda F.
- Venue
- JAMA: The Journal of the American Medical Association
- Publisher
- American Medical Association (AMA)
- Published
- 1997-04-09
- Volume
- 277
- Issue
- 14
- Pages
- 1140
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W1983608420
- Cited by
- 229
- References
- 101
- Citations by year
- 2023: 2 · 2022: 1 · 2021: 1 · 2020: 2 · 2018: 3 · 2017: 1 · 2016: 1 · 2015: 4 · 2014: 4 · 2013: 1 · 2012: 4
- FWCI
- 27.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality (1 PO1 HS 06503)
- U.S. National Library of Medicine (LM07092, T15LM007092)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Estrogen and related hormone effects
- Keywords
- hormone replacement therapy, postmenopausal women, life expectancy, coronary artery disease, breast cancer, hip fracture, endometrial cancer, cardiovascular risk factors, family history of breast cancer, individualized treatment decision-making
- MeSH terms
- Aged, Breast Neoplasms, Coronary Disease, Decision Support Techniques, Female, Hip Fractures, Humans, Life Expectancy, Middle Aged, Models, Theoretical, Risk, Risk Factors, Sensitivity and Specificity, Estrogen Replacement Therapy, Endometrial Neoplasms, Postmenopause, Black People, White People
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