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Tenth Anniversary of Initial Women

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Tenth Anniversary of Initial Women

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    3. Tenth Anniversary of Initial Women’s Health Initiative (WHI) Report What have we learned? How should the public be informed? What should a post-menopausal woman do, based on what we now know?

    4. WHI First report 2002 Two arms Placebo versus conjugated equine estrogen plus MPA (E+P) Placebo versus conjugated equine estrogen alone (E) 80% reduction in menopausal hormone use over the next five years

    5. WHI 10 years later: key conclusions after a decade of reflection Need to consider all information based on excess risk and benefit and not relative risk and benefit Only women just entering menopause are candidates for menopausal hormone therapy

    6. Initial WHI Report 2002 major finding

    9. Important Issue We need to distinguish between: relative risk absolute risk excess risk

    21. WHI 10 years later Relative risk is only important when absolute risk is high Example from common experience

    22. Example of relative vs absolute risk If you take one plane flight your chances of crashing are one in ten million (absolute risk) Your relative risk of crashing is increased by 500% if you take five plane flights . Your excess risk by taking five flights rather than one is four per ten million Bottom line: relative risk means little when absolute risk is low This is the reason to convert all WHI data to excess risk or benefit

    23. WHI 10 years later Need to consider all risk and benefit data consistently The Endocrine Society has expressed all risks and benefits as the number of women per 1000 using MHT for 5 years who will experience event

    26. WHI E+P

    28. Reduction in Mortality

    30. Timing Hypothesis Early vs. late treatment

    31. Timing Hypothesis Early vs. late treatment

    32. VTE and Stroke

    33. MHT 10 years after WHI only used at start of menopause

    36. MHT 10 years after WHI women with severe symptoms

    39. Assess risk of breast cancer and only treat those at low risk Low risk (i.e. 0.5% chance of breast cancer in 5 year) excess risk is 2.5/1000 per 5 years High risk (i.e. 4% chance of breast cancer in 5 years) excess risk 20/1000/5 years

    42. Calculation of Breast Cancer Risk Gail Model (http://www.cancer.gov/bcrisktoolmobile) Tyrer-Cuzick Model (http://pulsescreening.co.uk/Corporate/Breast_cancer_prediction_model-1.pdf)

    44. WHI after 10 years The Ultimate Goal is to provide the most benefit to the patient while avoiding the most risks

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