Part B-41-Risk and Benifit of Hormone Therapy

READING PASSAGE B

Risks and Benefits of Hormone Replacement Therapy Paragraph 1

Several recent large studies have provoked concern amongst both health professionals and the general public regarding the safety of hormone replacement therapy (HRT). This article provides a review of the current literature surrounding the risks and benefits of HRT in postmenopausal women, and how the data can be applied safely in everyday clinical practice. Paragraph 2

10

Worldwide, approximately 47 million women will undergo the menopause every year for the next 20 years.1 The lack of circulating oestrogens which occurs during the transition to menopause presents a variety of symptoms including hot flushes, night sweats, mood disturbance and vaginal atrophy, and these can be distressing in almost 50% of women. Paragraph 3

For many years, oestrogen alone or in combination with progestogens, otherwise known as hormone replacement therapy (HRT), has been the treatment of choice for control of problematic menopausal symptoms and for the prevention of osteoporosis. However, the use of HRT declined worldwide following the publication of the first data from the Women’s Health Initiative (WHI) trial in 2002.2 Paragraph 4

The results led to a surge in media interest surrounding HRT usage, with the revelation that 20 there was an increased risk of breast cancer and, contrary to expectation, coronary heart disease (CHD) in those postmenopausal women taking oestrogen plus progestogen HRT. Following this, both the Heart and Estrogen/Progestin Replacement Study Follow-up (HERS II)3,4 and the Million Women Study5 published results which further reduced enthusiasm for HRT use, showing increased risks of breast cancer5 and venous thromboembolism (VTE),4 and the absence of previously suggested cardioprotective effects3 in HRT users. The resulting fear of CHD and breast cancer in HRT users left many women with menopausal symptoms and few effective treatment options. Paragraph 5

Continued analysis of data relating to these studies has been aimed at understanding whether or not the risks associated with HRT are, in fact, limited to a subset of women. A 30 recent publication from the International Menopause Society6 has stated that HRT remains the first-line and most effective treatment for menopausal symptoms. In this article we examine the evidence that has contributed to common perceptions amongst health professionals and women alike, and clarify the balance of risk and benefit to be considered by women using HRT. Paragraph 6

One of the key messages from the WHI in 2002 was that HRT should not be prescribed to prevent age-related chronic disease, in particular CHD. This was contradictory to previous advice based on observational studies. However, recent subgroup analysis has shown that in healthy individuals using HRT in the early postmenopausal years (age 50–59 years), there was no increased CHD risk and HRT may potentially have a cardioprotective effect.8

Paragraph 7

Recent WHI data has suggested that oestrogen-alone HRT in compliant women under 60 years of age delays the progression of atheromatous disease (as assessed by coronary arterial calcification).9 The Nurses Health Study, a large observational study within the USA, 40 demonstrated that the increase in stroke risk appeared to be modest in younger women, with no significant increase if used for less than five years. Paragraph 8

Hormone replacement therapy is associated with beneficial effects on bone mineral density, prevention of osteoporosis and improvement in osteoarthritic symptoms. The WHI clearly demonstrated that HRT was effective in the prevention of all fractures secondary to osteoporosis.11 The downturn in HRT prescribing related to the concern regarding vascular and breast cancer risks is expected to cause an increase in fracture risk, and it is predicted that in the USA there will be a possible excess of !43,000 fractures per year in the near future.11 Paragraph 9

The WHI results published in 2002 led to a significant decline in patient and clinician 50 confidence in the use of HRT. Further analysis of the data has prompted a re-evaluation of this initial reaction, and recognition that many women may have been ‘denied’ treatment. Now is the time to responsibly restore confidence regarding the benefit of HRT in the treatment of menopausal symptoms when used judiciously. Hormone replacement therapy is undoubtedly effective in the treatment of vasomotor symptoms, and confers protection against osteoporotic fractures. Paragraph 10

The oncologic risks are relatively well characterised and patients considering HRT should be made aware of these. The cardiovascular risk of HRT in younger women without overt vascular disease is less well defined and further work is required to address this important question. In the interim, decisions regarding HRT use should be made on a case-by-case basis following informed discussion of the balance of risk and benefit. The lowest dose of hormone necessary to alleviate menopausal symptoms should be used, and the prescription reviewed on a regular basis. 60

Dr C Hardie, Dr C Bain, Dr M Walters

Risks and Benefits of Hormone Replacement Therapy 11. Which statement is the closest match to the description of the recent studies in Paragraph 1? a.) They demand a prompt review of current HRT practices. b.) They have shown that HRT can be used safely in clinical practice. c.) They have decreased the confidence of doctors and the public in HRT. d.) They have given menopausal women a new confidence to undergo HRT. 12. Which statement is the closest match to the description of projected menopause figures in Paragraph 2? a.) 47 international women will enter menopause annually for the next 20 years. b.) All women are likely to go through menopause if they live long enough. c.) 47 million women globally will enter menopause each year for the next 20 years. d.) Most women will succumb to menopause if they do not undertake HRT. 13. What cause does the article cite for the symptoms of menopause? a.) b.) c.) d.)

Lack of circulation Age Low progesterone levels Low FLUFXODWLQJestrogen levels

14. What has been the effect of the 2002 WHI study? a.) HRT has become less popular. b.) HRT has increased in popularity as the treatment of choice for problematic menopause symptoms. c.) There has been an increase in combined estrogen and progesterone therapy. d.) The women!s health initiative has since been established to investigate HRT. 15. Why were many women left with menopausal symptoms and no effective treatment? a.) b.) c.) d.)

They were unable to afford HRT treatments. They were concerned about coronary heart disease and breast cancer. They were concerned about breast cancer and venous thromboembulism. They were concerned about breast cancer and the cardioprotective effects.

PLEASE TURN OVER

Which of these statements is a TRUE summary of Paragraph 5?

16. a.) Surveys since WHI have attempted to find out if the WHI results are representative. b.) Results of past surveys are only valid for a subset of women, whether or not the public is aware of this. c.) The present study aims to show that HRT is safer than previously believed. d.) Women should ask their doctors to clarify the balance of risks and benefits of HRT. Which study showed an increased risk of VTE? 17. a.) b.) c.) d.)

The Nurses Health Study The Million Women Study The Women!s Health Initiative Study The WISDOM Study

18. Which of the following does the article recommend HRT should NOT be used to treat? a.) Vasomotor symptoms b.) Atheromatous disease c.) Age-related chronic disease d.) Osteoarthritic symptoms 19. Why were women “denied treatment”? (Paragraph 9) a.) b.) c.) d.)

Due to the decline in patient confidence in HRT Due to the results of studies including the WHI study Due to judicious use of HRT Due to a re-evaluation of this initial reaction

20. Which statement is NOT a recommendation of the present article? a.) b.) c.) d.)

Further study should be made into oncological risks of HRT Further study should be made into cardio vascular risks of HRT Doctors should now reassure their patients that HRT can be safe Doctors should prescribe the lowest effective dose for menopause symptoms

www.online-english-tutors.com Occupational English Test Practice Papers

Reading Test 1 – Answers Part A

Part B

1.

life expectancy

1. B

2.

2

2. C

3.

Sub Saharan Africa

3. B

4.

dementia

4. A

5.

Alzheimer’s Disease International

6.

2.4.2 million

7.

4.6 million

8.

non-fatal stroke

9.

60

10.

double

11.

Latin America

12.

80%

13.

2050

12. &

14.

risk exposure

13. '

15.

health transition

14. B

16.

sedentary lifestyles

15. C

17.

public health measures

16. D

18.

adult daycare centres

17. %

19.

supervision

18. C

20.

institutional care

19. $

21.

agitated

22.

rule out

23.

educate

24.

distraction

25.

Canadian

26.

onset

27.

4 years

5. B 6. C 7. D 8. B 9. A 10. A 11. C

20. A