It’s deja vu all over again
-Yogi Bera
If my practice is at all representative of the whole, then expect to read sometime soon that prescriptions for hormone replacement have dropped further in the wake of the recent news that breast cancers rates have declined since the publication of the Women’s Health Initiative in 2002.
In the past 2 weeks, I have had at least 5 patients come in for annuals either telling me that they stopped their HRT or wondering if they should stop as a result of the recent news. All of these women had been using HRT since the WHI results were published in 2002. All had been counseled extensively counseled about the risks of HRT as defined by that landmark study, had received written material outlining the risks, and had been offered non-hormonal alternatives for their symptoms. And all had wanted to continue to use HRT.
Until this new news came out.
The fact that these women are responding this way to these new findings may mean that they really did not believe the WHI findings in the first place, despite my counseling them in a way that I thought was factual and unbiased.
Or perhaps they believed the data, but also believed that it somehow did not apply to them.
Or perhaps it is simply because, as one patient told me – “You get scared when you see the risk you are taking splashed on the front page of the New York Times.”
So we sit and talk, review the numbers and the risks again, and they come again to a decision to use or not use HRT. One patient today decided to stay with HRT, figuring that since she had a major project due at work, this was not the time to upset the apple cart. Two decided to stay off and see how they do. One went onto an SSRI to help her wean off. Yet another finally went to the lower dose that I had been urging her to try.
I’ve asked them all if there was anything I could have said to them before now that would have dissuaded them from their decision to use HRT. Nothing. Did I portray the risks accurately for them? Yes. Should I have been more directive? No. Pushed them harder to avoid HRT? No.
All felt comfortable with the decision they had made previously, and all feel comfortable with the one they are making now. At least until the next news comes out.
It’s an ongoing process…
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Graph adapted from J Clin Oncology, 2006, 24 (30): 49E-50.
Category: Second Opinions
Let’s not forget the physicians who still attempt to prescribe HRT even for those of us with clotting issues/disorders and those with family histories of breast cancer. Whie I appreciate the advice and empathy (“I think you would be more comfortable”), why do I have to bring up the risk factors? It seems that sometimes patients have to educate our doctors on these issues.