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Gold, incentives and meh

Loss of confidence in HRT sees scripts plummet by a million

Shattered confidence in hormone replacement therapy has seen the number of prescriptions fall by a million, according to new figures.

The Prescription Pricing Authority found just 6.4 million HRT prescriptions were written in 2003, down from 7.4 million the year before, in the wake of adverse publicity from the US Women's Health Initiative and the UK's Million Women Study.

The studies linked HRT to breast cancer, stroke and heart disease.

GP Dr Anthony Seeley, a council member for the British Menopause Society, said the 13.5 per cent fall was very significant, mainly because of the lack of effective alternatives for vasomotor symptoms.

'There are unlicensed alternatives, such as SSRIs, but they're not very effective,' he said.

Dr Seeley added that he thought there would be a

further drop in HRT prescribing in 2004, followed by a swing back to HRT prompted by more recent data from

the oestrogen-only arm of

the WHI trial, which he felt suggested lower incidence of breast cancer – in contrast

to the Million Women study.

'We need to individualise treatment. Combined HRT in the long-term is not a good idea – low-dose oestrogen has much more to offer and we should consider tibolone as a useful alternative,' he said.

But new research in the BMJ (May 29) has added to the complexity of the risk-

benefit equation for HRT.

The study found HRT use is one of the main causes of false positive mammography, leading to anxiety and unnecessary biopsies in significant numbers of women.

During the period of study, HRT use accounted for 20 per cent of false positive recalls in the NHS breast screening programme, amounting to 14,000 extra 'cases'.

The study concluded the false positive rate was 64 per cent higher among HRT users than in non-users.

Lead author Dr Emily Banks, until recently deputy-director of Cancer Research UK's clinical epidemiology unit, said: 'Women who attend screening on HRT need to be aware of these risks of false positives. It's up to them to make the informed choice. There's no role for HRT in chronic disease management.'

HRT: a complex risk-benefits picture

Oestrogen plus progestin versus placebo resulted in:

lIncreased risk of heart attack

lIncreased risk of stroke

lIncreased risk of blood clots

lIncreased risk of breast cancer

lReduced risk of colorectal cancer

lFewer fractures

lNo protection against mild cognitive impairment and increased risk of dementia

Oestrogen alone versus placebo resulted in:

lNo difference in risk for heart attack

lIncreased risk of stroke

lIncreased risk of blood clots

lUncertain effect for breast cancer

lNo difference in risk for colorectal cancer

lReduced risk of fracture

By Rob Finch

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