Positive news from the WHI

Dear Friends and Colleagues,

Positive news from the WHI
This July it has been 18 years since the first report from the Women’s Health Initiative (WHI) study hit the world news headlines and shattered confidence in hormone therapy for menopausal symptoms and health optimization.
Co-incident with this ‘anniversary’, the WHI team has published a major analysis of the long-term (~20 year) follow-up of past participants in the WHI study in JAMA. They have reported that, compared with placebo, conjugated estrogen (CE)-only therapy was associated with a reduced risk of breast cancer as well as death from breast cancer, and that, although CE plus medroxyprogesterone acetate (MPA) was associated with a small increase in breast cancer risk, compared with placebo, combined therapy was not associated with a greater mortality from breast cancer. Both the risk reduction, and the risk increase seen with the formulations were modest. The key message that we need to impart to our patients, and our colleagues, is that it is now time to remove the negative stigma associated with HRT. This is our new headline: menopausal hormone therapy alleviates horrible symptoms experienced by most women, and for most women it is safe.

It is interesting that the authors pointed out CE-only is the first drug intervention shown to reduce breast cancer mortality in women without breast cancer, an effect not seen in chemoprevention studies with tamoxifen. The JAMA paper is available online and I encourage you all to consider this core reading and something important to share.

Chlebowski RT, Anderson GL, Aragaki AK, et al. Association of menopausal hormone therapy with breast cancer incidence and mortality during long-term follow-up of the Women's Health Initiative randomized clinical trials. JAMA 2020;324(4):369–80.