Hormone Replacement Therapy and Life Expectancy After Prophylactic Oophorectomy in Women With BRCA1/2 Mutations: A Decision Analysis

2004 ◽  
Vol 22 (6) ◽  
pp. 1045-1054 ◽  
Author(s):  
Katrina Armstrong ◽  
J. Sanford Schwartz ◽  
Thomas Randall ◽  
Stephen C. Rubin ◽  
Barbara Weber
Keyword(s):  
Hormone Replacement Therapy ◽  
Life Expectancy ◽  
Decision Analysis ◽  
Replacement Therapy ◽  
Prophylactic Mastectomy ◽  
Hormone Replacement ◽  
Sensitivity Analyses ◽  
Decision Analytic Model ◽  
Prophylactic Oophorectomy ◽  
The Impact

Purpose The decision about prophylactic oophorectomy is difficult for many premenopausal women with BRCA1/2 mutations because of concerns and controversy about the use of hormone replacement therapy (HRT) after oophorectomy. Patients and Methods A Markov decision analytic model used the most current epidemiologic data to assess the expected outcomes of prophylactic oophorectomy with or without HRT (to age 50 years or for life) in cohorts of women with BRCA1/2 mutations. Sensitivity analyses were conducted to assess the impact of alternative assumptions about effects of HRT, effects of prophylactic oophorectomy, and risks of cancer associated with BRCA1/2 mutations. Results In our model, prophylactic oophorectomy lengthened life expectancy in women with BRCA1/2 mutations, irrespective of whether HRT was used after oophorectomy. This gain ranged from 3.34 to 4.65 years, depending on age at oophorectomy. Use of HRT after oophorectomy was associated with relatively small changes in life expectancy (+0.17 to −0.34 years) when HRT was stopped at age 50, but larger decrements in life expectancy if HRT was continued for life (−0.79 to −1.09 years). HRT was associated with a gain in life expectancy of between 0.39 and 0.79 years for mutation carriers undergoing both prophylactic mastectomy and oophorectomy. Conclusion On the basis of the results of this decision analysis, we recommend that women with BRCA1/2 mutations undergo prophylactic oophorectomy after completion of childbearing, decide about short-term HRT after oophorectomy based largely on quality-of-life issues rather than life expectancy, and, if using HRT, consider discontinuing treatment at the time of expected natural menopause, approximately age 50 years.

scholarly journals Association of supplemental calcium and dairy milk intake with all-cause and cause-specific mortality in the UK Biobank: a prospective cohort study

2019 ◽  
Vol 123 (5) ◽  
pp. 574-582 ◽  
Author(s):  
L. C. Stasinopoulos ◽  
A. Zhou ◽  
E. Hyppönen
Keyword(s):  
Hormone Replacement Therapy ◽  
Replacement Therapy ◽  
Cancer Mortality ◽  
Hormone Replacement ◽  
Sensitivity Analyses ◽  
Milk Consumption ◽  
Inverse Association ◽  
Uk Biobank ◽  
Supplement Use ◽  
Increased Risk

AbstractExcessive Ca intakes have been proposed to associate with vascular calcification and a higher risk of prostate cancer. We investigated the associations of supplemental and dietary Ca intake with mortality using data from 497 828 UK Biobank participants. The average follow-up was 4·2 years and 14 255 participants died, 8297 from cancer, 2959 from CVD and 572 from respiratory disease. The use of Ca supplements and milk consumption were associated with differences in mortality in younger (≤65 years) but not in older participants (>65 years, Pinteraction ≤ 0·04 for all comparisons). Among participants <65 years, there was an inverse association between Ca supplementation (OR 0·91, 95 % CI 0·83, 0·99) and milk consumption (OR 0·93, 95 % CI 0·86, 1·00) with respect to all-cause mortality. In the same age group, milk drinkers had lower odds of cancer mortality (OR 0·89, 95 % CI 0·80, 0·98) but Ca supplement use was associated with increased odds of respiratory mortality (OR 1·69, 95 % CI 1·16, 2·74). All associations in participants aged ≥65 years were null after full adjustment. In sensitivity analyses stratified by hormone replacement therapy, Ca supplement use was associated with decreased odds of cancer mortality in users but increased risk in other women (OR 0·81, 95 % CI 0·69, 0·94 v. OR 1·17, 95 % CI 1·01, 1·35, respectively). To conclude, we saw little evidence for harm with dietary or supplemental Ca. Further studies are required to confirm the proposed interaction with hormone replacement therapy and to exclude reverse causation as a determinant in the association between Ca supplements and increased risk of respiratory diseases.

Sex Hormone Replacement Therapy in Turner Syndrome: Impact on Morbidity and Mortality

2019 ◽  
Vol 105 (2) ◽  
pp. 468-478 ◽  
Author(s):  
Mette H Viuff ◽  
Agnethe Berglund ◽  
Svend Juul ◽  
Niels H Andersen ◽  
Kirstine Stochholm ◽  
...  
Keyword(s):  
Hormone Replacement Therapy ◽  
Replacement Therapy ◽  
Turner Syndrome ◽  
Hormone Replacement ◽  
Osteoporotic Fractures ◽  
Long Term Effects ◽  
Mortality And Morbidity ◽  
Central Registry ◽  
National Cohort ◽  
The Impact

Abstract Context The long-term effects of female hormone replacement therapy (HRT) in Turner syndrome (TS) are unknown. Objective To examine morbidity, mortality and medicinal use in TS and the impact of HRT in 45,X women. Design and Setting National cohort study, following all TS individuals ever diagnosed in Denmark from 1977 to 2014. Patients and Methods In the Danish Cytogenetic Central Registry, we identified 1156 females diagnosed with TS from 1960 to 2014, and, subsequently, Statistics Denmark randomly identified 115 577 age-matched female controls. TS women and their matched controls were linked with person-level data from the National Patient Registry and the Medication Statistics Registry, and they were compared concerning mortality, hospitalizations, and medical prescriptions. Among 329 45,X women, 44 had never been HRT treated, and 285 had been treated at some point. HRT treated women were compared with untreated concerning mortality, hospitalizations, and medical prescriptions. Results Endocrine and cardiovascular mortality and morbidity were significantly increased in TS compared with the matched controls. Comparing HRT treated with nontreated 45,X women, we found a similar mortality (hazard ratio 0.83, 95% confidence interval 0.38–1.79). Among the HRT-treated 45,X women, we found a significantly lower use of antihypertensives, antidiabetics, and thyroid hormones and significantly reduced hospitalization rates for stroke and osteoporotic fractures. Conclusion Women with TS have an increased overall mortality and morbidity. HRT seems to have a beneficial effect on endocrine conditions, hypertension, and stroke in women with 45,X karyotype, with no clear impact on mortality.

A decision analytic model of prostate cancer screening using prostate-specific antigen and digital rectal exam

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5155-5155
Author(s):  
J. H. Hayes ◽  
M. J. Barry ◽  
P. W. Kantoff ◽  
J. E. Stahl
Keyword(s):  
Prostate Cancer ◽  
Life Expectancy ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Decision Analytic Model ◽  
Digital Rectal Exam ◽  
Psa Screening ◽  
The Impact

5155 Background: PSA-based screening has been widely adopted in the US although a mortality benefit has yet to be demonstrated. The disutility of screening and quality of life of men diagnosed and treated after screening are critical issues in assessing its benefit and harm. The purpose of this model is to estimate the effect of one-time screening for prostate cancer using Prostate Specific Antigen (PSA) and DRE (digital rectal exam) on life expectancy (LE) and Quality Adjusted Life Expectancy (QALE) in the context of current diagnostic and treatment practice. Methods: A semi-Markov state transition simulation describes the relevant health states. Two strategies were compared: 1) Screening - single screening PSA and DRE; 2) No Screening - patients diagnosed after developing symptoms. Markov cycle length was 1 year. Transition probabilities and utility weights were developed from review of the literature and expert opinion. Sensitivity analyses were performed on all parameters. A PSA threshold of 4 ng/mL and age 65 were used for the base case. The model was created using TreeAge software. Results: For our base case, a single screening conferred a LE benefit of 0.37 y (15.86 vs 15.49 y) and a QALE benefit of 0.20 QALYs (15.62 vs 15.42 QALYs). Predicted 10 y cancer specific survival for screen-diagnosed men was 95.7% vs SEER 97.7%. The model predicted 9.5% of screened patients would have metastatic disease at diagnosis vs 5% in SEER (4% unknown stage); in unscreened men, this rate was 18/100,000 vs 15/100,000 in SEER. Sensitivity Analyses of Utilities (SA): The single screen model was relatively insensitive to SA of utilities: a 20% single cycle toll on one-time PSA screening disutility was required to eliminate the benefit of screening. The disutility of positive PSA with negative biopsy slightly affected QALE: a toll of 0.25 QALYs decreased QALE from 15.62 to 15.61 QALYs. Conclusions: Our model reveals a modest benefit to one-time screening for prostate cancer. This one-time screening model is relatively insensitive to utility SA; however, the importance of incorporating psychological effects of PSA screening in recurrent screening is to be determined. The impact of serial screening, lead time, PSA threshold, and cost effectiveness on LE and QALE is being analyzed. No significant financial relationships to disclose.

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