Changes in the use of postmenopausal hormone therapy after the publication of clinical trial results
Changes in the use of postmenopausal hormone therapy after the publication of clinical trial results
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DOI：
10.7326/0003-4819-140-3-200402030-00009
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发表时间：
2004-02-03
影响因子：
39.2
通讯作者：
Kerlikowske, K
中科院分区：
文献类型：
--
作者：
Haas, JS;Kaplan, CP;Kerlikowske, K
背景资料：最近发表的临床试验结果导致了绝经后激素治疗证据的戏剧性转变。目的：研究临床试验结果的发表，特别是1998年的心脏和雌激素/孕激素替代研究（HERS）和2002年的妇女健康倡议（WHI），是否影响了绝经后妇女使用激素治疗。设计：观察性队列地点：San弗朗西斯科乳腺X线摄影登记处，San弗朗西斯科，加州。参与者：年龄在50 - 74岁之间的绝经后妇女，没有乳腺癌个人病史，接受了乳腺X线摄影（151862乳房X光片）。测量：自我报告的目前使用激素therapy.Results：在绝经妇女谁有乳房X光检查，据估计，41%目前正在使用激素治疗在1997年。在HERS发表之前，激素治疗的使用以每季度1%（95%CI，0%至2%）的速度增加。在HERS出版后，使用率每季度下降1%（CI，-3%至0%）。相比之下，2002年WHI的发表与激素治疗使用的更大幅度下降有关，每季度下降18%（CI，-21%至16%）。在大多数女性亚组中也观察到类似的相关性，包括年龄大于65岁的女性;既往子宫切除术的女性;以及描述其种族或民族为白色、非洲裔美国人、拉丁裔、中国人或菲律宾人的女性。相比之下，WHI主要发现的发布与绝经后妇女使用的更大幅度下降有关。下降差异的原因可能与WHI结果被广泛宣传或更适用于大多数绝经后妇女有关，因为WHI研究是在健康妇女中进行的。
Background: The recent publication of clinical trial results has led to a dramatic shift in the evidence about postmenopausal hormone therapy.Objective: To examine whether the publication of clinical trial results, specifically the Heart and Estrogen/progestin Replacement Study (HERS) in 1998 and the Women's Health Initiative (WHI) in 2002, has influenced the use of hormone therapy among postmenopausal women.Design: Observational cohort (1997 to 2003).Setting: San Francisco Mammography Registry, San Francisco, California.Participants: Postmenopausal women between the ages of 50 and 74 years without a personal history of breast cancer who underwent mammography (151862 mammograms).Measurements: Self-reported current use of hormone therapy.Results: Among menopausal women who had mammography, it was estimated that 41% were currently using hormone therapy in 1997. Before the publication of HERS, the use of hormone therapy was increasing at a rate of 1% (95% Cl, 0% to 2%) per quarter. After the publication of HERS, use decreased by 1% (Cl, -3% to 0%) per quarter. In contrast, the publication of the WHI in 2002 was associated with a more substantial decline in the use of hormone therapy of 18% (Cl, -21% to -16%) per quarter. Similar associations were observed for most subgroups of women, including women older than 65 years of age; women with a previous hysterectomy; and women who described their race or ethnicity as white, African American, Latina, Chinese, or Filipina.Conclusions: The release of the HERS data was temporally associated with a modest decline in the use of hormone therapy. In contrast, the release of the principal findings from the WHI was associated with a more substantial decline in use by postmenopausal women. The reason for the differences in decline may relate to the fact that the WHI results were widely publicized or were more applicable to most postmenopausal women because the WHI study was performed in healthy women.