MEGATRIALS OF HORMONAL REPLACEMENT THERAPY

Despite the fact that estrogen replacement therapy has been demonstrat ed to be of great value to postmenopausal women, many patients are sti ll reluctant to use it. This is primarily because of fears that sex ho rmone therapy increases the risk of developing uterine and breast canc er. Because retrospective epidemiolog ical studies have failed to clar ify the issue for breast cancer, ambitious prospective trials have bee n initiated to determine the role of hormones in the development of br east cancer and cardiovascular disease. The main studies have been the Women's Health Initiative, the Postmenopausal Estrogen/Progestin Inte rvention (PEPI) Trial, the Heart and Estrogen-Progestin Replacement St udy (HERS), the Women's International Study of long Duration Oestrogen after Menopause (WISDOM) and the Million Women Study. Only the PEPI T rial has been completed. It showed a substantial benefit for women usi ng hormone replacement therapy, but was insufficiently powerful to det ermine whether such therapy affected the incidence of breast cancer. D espite the immense costs involved and the considerable time that must elapse before results are published, it is imperative that these major prospective studies are completed, analysed and published. Only then can physicians advise their patients in an appropriate manner.