breast cancer risk and ht focus on progestogens l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Breast Cancer Risk and HT: Focus on Progestogens PowerPoint Presentation
Download Presentation
Breast Cancer Risk and HT: Focus on Progestogens

Loading in 2 Seconds...

play fullscreen
1 / 17

Breast Cancer Risk and HT: Focus on Progestogens - PowerPoint PPT Presentation


  • 578 Views
  • Uploaded on

Breast Cancer Risk and HT: Focus on Progestogens Andrew M. Kaunitz, MD Professor and Associate Chairman Department of Obstetrics and Gynecology University of Florida College of Medicine Jacksonville, Florida Daniel R. Mishell Jr, MD Lyle G. McNeile Professor

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Breast Cancer Risk and HT: Focus on Progestogens' - adamdaniel


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
breast cancer risk and ht focus on progestogens
Breast Cancer Risk and HT:Focus on Progestogens

Andrew M. Kaunitz, MD

Professor and Associate Chairman

Department of Obstetrics and Gynecology

University of Florida College of Medicine

Jacksonville, Florida

Daniel R. Mishell Jr, MD

Lyle G. McNeile Professor

Department of Obstetrics and Gynecology

Keck School of Medicine

University of Southern California

Los Angeles, California

An online offering from

breast cancer in the whi
Breast Cancer in the WHI
  • E+P: HR 1.24 (weighted P<.001)
  • E-alone: HR 0.77 (P=.09)

E, estrogen; HR, hazard ratio; P, progestin; WHI, Women’s Health Initiative.

Stefanick ML, et al. JAMA. 2006;295:1647-1657. Chlebowski RT, et al. JAMA. 2003;289:3243-3253.

observational data
Observational Data
  • Nurses’ Health Study: Breast cancer risk with E-alone
    • <5 years: RR 0.96 (95% CI, 0.75-1.22)
    • 5-9.9 years: RR 0.90 (95% CI, 0.73-1.12)
    • 10-14.9 years: RR 1.06 (95% CI, 0.87-1.30)
    • 15-19.9 years: RR 1.18 (95% CI, 0.95-1.48)
    • 20+ years: RR 1.42 (95% CI, 1.13-1.77)
  • Finnish experience with systemic estrogen-only for less than 5 years’ duration:
    • Incidence ratio: 0.93 (95% CI, 0.80-1.04)

CI, confidence interval; RR, relative risk.

Chen WY, et al. Arch Intern Med. 2006;166:1027-1032.Lyytinen H, et al. Obstet Gynecol. 2006;108:1354-1360.

2005 meta analysis
2005 Meta-analysis
  • 4 randomized trials
    • E-alone: 0.79 (95% CI, 0.61-1.02)
    • E+P: 1.24 (95% CI, 1.03-1.50)
  • Observational studies with current use
    • E-alone: 1.18 (95% CI, 1.01-1.38)
    • E+P: 1.70 (95% CI, 1.36-2.13)

Collins JA, et al. Hum Reprod Update. 2005;11:545-560.

gland mitoses in human breast and endometrium according to cycle day

Cytoplasmic Vacuoles

Gland Mitosis

1 7 14 21 28

Menses

Proliferative

Phase

Secretory

Phase

Gland Mitoses in Human Breast and Endometrium According to Cycle Day

Breast

Endometrium

Longacre TA, Bartow SA. Am J Surg Pathol. 1986;10:382-393.

risk benefit ratio cancer risks in the million women study
Risk/Benefit Ratio:Cancer risks in the Million Women Study

Standardized incidence rate per 1000 women over 5-year period

Endometrial Breast Cancer Cancer

Baseline 3.0 13.6

E-alone 4.9 18.0

E+P 2.0 29.3

Beral V, et al. Lancet. 2005;365:1543-1551.

breast cancer risk with e p by duration of use
Breast Cancer Risk with E+P by Duration of Use
  • <5 years: 1.34 (95% CI, 1.13-1.59)
  • ≥5 years: 1.89 (95% CI, 1.54-2.31)

Meta-analysis of the epidemiologic data, 2005

Collins JA, et al. Hum Reprod Update. 2005;11:545-560.

progestogens used in us postmenopausal ht regimens
Progestogens Used in US Postmenopausal HT Regimens
  • Medroxyprogesterone acetate
  • Norethindrone acetate
  • Levonorgestrel
  • Micronized progesterone
french cohort study
French Cohort Study
  • E-alone vs never use:RR 1.29 (95% CI, 1.02-1.65)
  • Oral estrogen-MPA:RR 1.48 (95% CI, 1.02-2.16)
  • Oral estrogen-norethindrone acetate:RR 2.11 (95% CI, 1.56-2.86)
  • Transdermal estrogen-progesterone:RR 1.08 (95% CI, 0.89-1.31)

MPA, medroxyprogesterone acetate.

Fournier A, et al. Breast Cancer Res Treat. 2007;Feb 27 [Epub ahead of print].

micronized progesterone
Micronized Progesterone
  • Approved by the FDA for prevention of endometrial hyperplasia in menopausal women using estrogen who have a uterus.
  • Biochemically identical to the progesterone produced by the ovaries during a woman’s reproductive years.
transdermal estrogen
Transdermal Estrogen
  • All non-oral estrogen formulations are estradiol, which is biochemically identical to the estrogen produced by reproductive aged women.
  • Unlike oral estrogen, transdermal estrogen does not appear to increase the risk of venous thromboembolism because it avoids the first pass through the liver.1

1Canonico M, et al. Circulation. 2007;115:840-845.

reassuring messages
Reassuring Messages
  • Estrogen alone does not alter breast cancer risk.
  • E+P increases risk, but only with use for 5 years or more.
  • Recent data show that transdermal estrogen with micronized progesterone may be particularly safe.
use of oral micronized progesterone
Use of Oral Micronized Progesterone
  • 100 mg and 200 mg doses
  • Formulations contain peanut oil
  • May cause sleepiness
  • Use in women with a uterus who are taking estrogen
    • MP, 200 mg, for cyclic use (days 1-10 or 1-14 of each month)
    • MP, 100 mg, for daily use at bedtime*

*This regimen is not FDA approved.