Leading HRT experts not consulted over NHS menopause guidance
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Version 0 of 1. The UK’s leading experts on the cancer risks of hormone replacement therapy were not invited to give evidence to the committee preparing guidance for the NHS on treating the menopause, the Guardian has learned. Prof Klim McPherson from Oxford University, who has written many papers on HRT and sat on the government’s committee on the safety of medicines when it warned doctors to prescribe as little HRT for as short a time as possible for women suffering symptoms, was not aware the guidance was being formulated until recently. Prof Valerie Beral, also at Oxford, who leads the Million Women Study (MWS), which identified an increased risk of breast and ovarian cancer with the use of the drugs, was also not asked for her views. McPherson said he had not been consulted at all and that it was “outrageous” Beral had not been contacted by the committee. Related: HRT media campaign underplays cancer risks, critics say “I just find it absolutely unbelievable that they can produce guidelines on HRT without speaking to me or Val. It is absolutely ludicrous, considering the people they have spoken to,” he said. The menopause guidance will be published by the National Institute for Health and Care Excellence (Nice) on Thursday. The scope is broader than HRT, but recommendations concerning the drugs are expected to be central to it. A drug company-funded PR campaign has already begun to encourage wider use of the drugs, as the Guardian reported on Saturday. In the 1960s, HRT was promoted as an elixir of youth. It was highly effective in ending the symptoms of the menopause, which affect 80% of women, but 20% of them severely. These include hot flushes, night sweats, insomnia, mood swings and tiredness. The pills also reduced fractures by improving bone density, and were expected to reduce deaths from heart disease and strokes. But the large Women’s Health Initiative (WHI) study in the US, designed to prove HRT protected women from heart attacks, had to be stopped early when it became clear it did not and that it doubled deaths from breast cancer. The results, published in 2002, and those of the Million Women Study in 2003, which confirmed the breast cancer risk, had a major impact on public confidence. The numbers of women taking HRT dropped dramatically and so did the numbers of women diagnosed with breast cancer. McPherson said: “The breast cancer incidence went down noticeably. In whole populations.” The committee on the safety of medicines said doctors could continue to prescribe HRT, which was an effective treatment for the symptoms of the menopause, but they should offer women the lowest dose that worked for them for as short a period of time as possible. Since then, many articles have been written, often in small medical journals with low circulations, taking issue with the evidence against HRT and the way the WHI and MWS trials were carried out, McPherson said. The articles claim the findings are not robust because the WHI study looked at HRT in women older than the under-60 age group that might be prescribed it, and the products and doses were different. They also claim the MWS is flawed because it is observational, following women to see which of those on HRT develop breast cancer, rather than comparing one group of women on the drugs with a comparable group of women who are not. Beral and colleagues say the size of the study overcomes that problem, because a substantial proportion of the population aged about 50 was recruited. McPherson said the effect of the critical articles is “a winding down of the evidence base until you can point to the fact that this apparent association between HRT and breast cancer is neither here nor there and not terribly important. Meanwhile, people are getting breast cancer. It’s appalling.” Nice declined to respond to the criticism ahead of publication of the guidance on Thursday. |