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*2003³â 6¿ù 25ÀÏ Ãß°¡ÇÕ´Ï´Ù. º¹ÇÕ HRT¿Í À¯¹æ¾Ï À§Çè¿¡ °üÇÑ ¾Æ·¡ µ¿¾ÆÀϺ¸ ±â»ç¸¦ ÂüÁ¶ÇϽñ⠹ٶø´Ï´Ù. 2002³â NIHÀÇ ÀڷḦ ½ÉÃþ ºÐ¼®ÇÑ °á°ú¶ó°í ÇÕ´Ï´Ù. ±×¸®°í 2002³â 4¿ù 18ÀÏ ½ºÄÎƽ½º/´º½º¿¡ °Ô½ÃÇß´ø "»êºÎÀΰú »çÀÌÆ®ÀÇ È£¸£¸ó º¸Ãæ¿ä¹ý°ú ¾Ï"Àº ÀÌ ±ÛÀÇ Á¦ÀÏ ¹ØÀ¸·Î ¿Å±â°í ±×°÷ ±ÛÀº »èÁ¦ÇÏ¿´½À´Ï´Ù. 

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°»³â±â Áúȯ º¹ÇÕÈ£¸£¸ó ¿ä¹ý "À¯¹æ¾Ï À¯¹ß-ÃËÁø-ÀºÆó"

°»³â±âÁúȯ Ä¡·á¿¡ Ưȿ°¡ ÀÖ´Â °ÍÀ¸·Î ¾Ë·ÁÁø º¹ÇÕ È£¸£¸ó ¿ä¹ýÀÌ À¯¹æ¾Ï À§ÇèÀ» 3ÁßÀ¸·Î °¡Áß½Ãų ¼ö ÀÖ´Ù´Â ¿¬±¸ °á°ú°¡ ³ª¿Ô´Ù°í ´º¿å ŸÀÓ½º°¡ 25ÀÏ º¸µµÇß´Ù.

º¹ÇÕ È£¸£¸ó ¿ä¹ýÀÌ ¾Ç¼º À¯¹æ¾ÏÀ» ÀÏÀ¸Å³ »Ó¸¸ ¾Æ´Ï¶ó À¯¹æ¾Ï ÁøÇàÀ» ÃËÁø½ÃÅ°´Â ÇÑÆí Ä¡·á°¡ ¾î·Á¿î ´Ü°è±îÁö ¾Ï ¹ß°ßÀ» ÀºÆóÇÒ ¼ö ÀÖ´Ù´Â °Í.

ÀÌ´Â Áö³­ÇØ 7¿ù ¹Ì±¹ ±¹¸³º¸°Ç¿ø(NIH)ÀÌ È£¸£¸ó ¿ä¹ýÀÌ ³úÁßdz°ú À¯¹æ¾Ï, ½ÉÀå¹ßÀÛÀ» À¯¹ßÇÒ ¼ö ÀÖ´Ù´Â º¸°í¼­¸¦ ¹ßÇ¥ÇÑ ÀÌÈÄ Ãß°¡·Î ºÎÀÛ¿ëÀÌ ¹àÇôÁø °ÍÀ̾ ÆÄÀåÀÌ ¿¹»óµÈ´Ù.

ÇϹö-UCLA ÀÇÇм¾ÅÍ Á¾¾çÇÐÀÚÀÎ ·Î¿Ï Ŭ·¹º¸½ºÅ° ¹Ú»ç´Â ¹Ì±¹ÀÇÇÐÇùȸÁö(JAMA) ÃÖ½ÅÈ£¿¡ ¹ßÇ¥ÇÑ °øµ¿¿¬±¸º¸°í¼­¿¡¼­ ¿¡½ºÆ®·Î°Õ-ÇÁ·Î°Ô½ºÅ×·Ð º¹ÇÕÈ£¸£¸óÁ¦Á¦(¾àÇ°¸í ÇÁ·½ÇÁ·Î)¿¡ ÀÌ °°Àº À§ÇèÀÌ ÀÖ´Ù´Â »ç½ÇÀÌ È®ÀÎµÆ´Ù°í ¹àÇû´Ù.

¿¬±¸ÁøÀÌ Áö³­ÇØ NIH ¿¬±¸¿¡ ÀοëµÈ 1¸¸1608¸íÀÇ Æó°æ±â ¿©¼ºÀڷḦ ½ÉÃþ ºÐ¼®ÇÑ °á°ú È£¸£¸ó ¿ä¹ýÀ» ¹ÞÀº À¯¹æ¾Ï ȯÀÚÀÇ ¾Ï¼¼Æ÷ ÀüÀÌÀ²Àº 25.4%·Î, À§¾àÀ» Åõ¿©ÇÑ È¯ÀÚ±×·ìÀÇ 16%º¸´Ù ÇöÀúÈ÷ ³ô¾Ò´Ù.

Á¾¾ç Å©±âµµ È£¸£¸ó ¿ä¹ý ±×·ìÀÌ Æò±Õ 1.7cm·Î À§¾à Åõ¿© ±×·ìÀÇ 1.5cmº¸´Ù ÇöÀúÈ÷ ÄÇ´Ù. 1³â°£ Ä¡·á¸¦ ¹ÞÀº µÚ È£¸£¸ó ¿ä¹ý ±×·ìÀº 9.4%°¡ ¿©ÀüÈ÷ À¯¹æ X¼± ÃÔ¿µ¿¡¼­ ÀÌ»óÀ» º¸¿´Áö¸¸ À§¾à Åõ¿© ±×·ìÀº 5.4%¿¡¼­ ÀÌ»óÀÌ ³ªÅ¸³µ´Ù.

À¯¹æ¾Ï ¹ß»ý ºñÀ²µµ È£¸£¸ó ¿ä¹ý ±×·ìÀÌ 24%³ª ³ô¾Ò´Âµ¥, À̴ ȣ¸£¸óÀ» º¹¿ëÇϱ⠽ÃÀÛÇÑ 2³â µ¿¾È¿¡´Â ³ªÅ¸³ªÁö ¾Ê¾Æ ÁøÇà¼Óµµ´Â ºü¸£¸é¼­µµ ¾Ï Æ÷Âø ½Ã±â´Â ´Ê´Ù´Â °ÍÀ» º¸¿©ÁØ´Ù.

¿¬±¸ÁøÀº ÇöÀç 300¸¸¸íÀÇ º¹ÇÕ È£¸£¸ó º¹¿ëÀÚ °¡¿îµ¥ ¸Å³â 12¸¸¸íÀÌ À¯¹æ ÀÌ»ó Áõ»óÀ» ³ªÅ¸³¾ ¼ö ÀÖ´Ù°í Ãß»êÇß´Ù.

Áö³­ÇØ NIH ¿¬±¸ °á°ú°¡ ¹ßÇ¥µÈ ÀÌÈÄ ¹Ì±¹¿¡¼­ º¹ÇÕ È£¸£¸ó º¹¿ëÀÚ°¡ 50%°¡·® ÁÙ¾úÀ¸¸ç, ´ç±¹Àº º¹ÇÕ È£¸£¸ó º¹¿ëÀ» ÃÖ¼ÒÈ­ÇÏ°í ºÒ°¡ÇÇÇÒ °æ¿ì ÃÖ¼Ò·®¿¡ ÇÑÁ¤Çϵµ·Ï ´çºÎÇÏ°í ÀÖ´Ù.

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2002³â 4¿ù 18ÀÏ "½ºÄÎƽ½º/´º½º"¿¡ "»êºÎÀΰú »çÀÌÆ®ÀÇ È£¸£¸ó º¸Ãæ¿ä¹ý°ú ¾Ï"À̶ó´Â ±ÛÀ» °Ô½ÃÇÑ ÀûÀÌ ÀÖ½À´Ï´Ù. ¸î °³ »êºÎÀΰú »çÀÌÆ®ÀÇ È£¸£¸ó ´ëü¿ä¹ý(HRT, ÀÌ°÷¿¡¼­´Â º¸Ãæ¿ä¹ýÀ̶ó°í ºÎ¸¨´Ï´Ù) °Ô½Ã¹°¿¡ À¯¹æ¾Ï µî ¾Ï ¹ß»ý À§ÇèÀÌ ¾ø´Â °Íó·³ Ç¥±âÇÑ ¹®Á¦¸¦ »ìÆ캸¾Ò½À´Ï´Ù. ±×¸®°í 2002³â 5¿ù 10ÀÏ °­³²Â÷º´¿ø ÀÌÁ¤³ë ±³¼ö°¡ ¹æ¼Û¿¡ ³ª¿Í Áú¹®¿¡ ´äÇÏ´Â °¡¿îµ¥ HRT°¡ "¾Ï°ú ÀüÇô °ü°è°¡ ¾ø´Ù"°í ¸»ÇÏ´Â °ÍÀ» Á÷Á¢ µè°í ³î¶ó ±× ³»¿ëÀ» º¸ÃæÇß½À´Ï´Ù.

1. ÃÖ±Ù º¸µµµÈ HRT º¹ÇÕ ¿ä¹ýÀÇ ¹®Á¦

2002³â 7¿ù 9ÀÏ ¹Ì NIH´Â ¾ð·Ð º¸µµ¹®À» ÅëÇØ ¿¡½ºÆ®·Î°Õ, ÇÁ·Î°Ô½ºÆ¾ º¹ÇÕ HRT ÀÓ»ó ½ÃÇèÀ» Áß´ÜÇÑ´Ù°í ¹ßÇ¥Çß°í °ð 7¿ù 17ÀÏ <¹ÌÀÇ»çÇùȸÁö>¿¡´Â ÀÚ¼¼ÇÑ ÀÓ»ó °á°ú°¡ ½Ç·È½À´Ï´Ù. À̹ø ÀÓ»ó ½ÃÇè¿¡´Â ¹Ì±¹ Á¦¾àȸ»ç ¿ÍÀ̾(Wyeth)ÀÇ Prempro°¡ »ç¿ëµÆ½À´Ï´Ù.

1993³âºÎÅÍ 1998³â »çÀÌ¿¡ 27,000¸íÀÇ Æó°æ ¿©¼ºÀÌ Âü¿©ÇÑ(Áßµµ Å»¶ôµµ ÀÖÀ» °ÍÀÔ´Ï´Ù) ÀÌ ÀÓ»ó ½ÃÇèÀº 2005³â±îÁö °è¼ÓµÉ ¿¹Á¤À̾ú´Âµ¥ À̹ø¿¡ HRT º¹ÇÕ ¿ä¹ý ½ÃÇèÀ» Áß´ÜÇÑ °ÍÀÔ´Ï´Ù.  Áß´Ü ÀÌÀ¯´Â HRT º¹ÇÕ ¿ä¹ýÀÌ ÇýÅÿ¡ ºñÇØ À§ÇèÀÌ Å« °ÍÀ¸·Î ÆǸíµÆ±â ¶§¹®À̶ó°í ÇÕ´Ï´Ù. ±¸Ã¼ÀûÀ¸·Î À¯¹æ¾Ï, ½ÉÀå ¹ßÀÛ, ³úÁ¹Áß ±×¸®°í Ç÷¾× ÀÀ°íÀÇ À§ÇèÀÌ °ñÀý°ú °áÀåÁ÷Àå¾ÏÀÇ °¨¼Ò ÇýÅÃÀ» ¾ÐµµÇÑ´Ù°í Çß½À´Ï´Ù. ÀÌ·± °æ¿ì À±¸®ÀûÀ¸·Î ÀÓ»ó ½ÃÇè Áß´ÜÀº ´ç¿¬ÇÕ´Ï´Ù. 

ÀÌ»ó ³»¿ëÀº ¹Ì È­ÇÐȸ ´º½º·¹ÅÍ(¾Æ·¡ ÷ºÎ)¿Í ¾à¾÷°è ½Å¹®¿¡¼­ Á¢ÇÑ °ÍÀÔ´Ï´Ù. ƯÈ÷ Premarin µî HRT Á¦Á¦¸¦ »ý»êÇÏ´Â(ÀÌ ºÐ¾ß 2001³â 20¾ï ´Þ·¯ ¸ÅÃâ,  Prempro°¡ ÀÌÁß 40%) ¿ÍÀ̾ÀÇ ¹®Á¦¸¦ À¯½ÉÈ÷ º¸¾Ò½À´Ï´Ù. NIHÀÇ º¸µµ¹®ÀÌ ³ª¿Â 2002³â 7¿ù 9ÀÏ ÀÌ È¸»çÀÇ ÁÖ°¡´Â 24%°¡ ¶³¾îÁ³´Ù°í ÇÕ´Ï´Ù. ÀÌ¿¡ ´ëÀÀÇÏ¿© (±¹³») ¿ÍÀ̾´Â ´ÙÀ½°ú °°ÀÌ ¸»ÇÑ °ÍÀ¸·Î º¸µµµÆ½À´Ï´Ù.

"ÀÚ±ÃÀ» ÀûÃâÇÑ ¿©¼ºÀº ¿¡½ºÆ®·Î°Õ¸¸ ´Üµ¶À¸·Î º¹¿ëÇÏ´Â °ÍÀ̹ǷΠÇöÀç ´ë·Î ó¹æÀ» ÇÏ¸é µÇ°í, ÀÚ±ÃÀÌ ÀÖ´Â ¿©¼º¿¡°Ô º¹ÇÕÁ¦Á¦¸¦ ó¹æÇÒ ¶§µµ Æó°æÁõ»ó°ú °ñ´Ù°øÁõÀ» À§ÇØ ´Ü±â°£ ó¹æÇÏ´Â °ÍÀº ÀÌÁ¡ÀÌ ÈξÀ ¸¹À¸¸ç ´Ù¸¸ Àå±â°£ ó¹æÇÒ ÇÊ¿ä°¡ ÀÖÀ» °æ¿ì¿¡´Â À§Çè°ú ÀÌÁ¡À» °³º°ÀûÀ¸·Î Æò°¡ÇÒ °ÍÀ» ±Ç°íÇÑ ºÏ¹ÌÆó°æÇÐȸ¿Í ¹Ì±¹ »êºÎÀΰú ÀÇ»çȸ, ´ëÇÑÆó°æÇÐȸÀÇ °ßÇظ¦ µé¾î °³º° ´ëÀÀÀ» ÁÖ¹®Çß´Ù."

±×·¯´Ù°¡ ´ëÇÑÆó°æÇÐȸ »çÀÌÆ®¿¡¼­ "¿ì¸®ÀÇ °ßÇØ" ½ÄÀÇ ±ÛÀ» ¹ß°ßÇߴµ¥ ³³µæÇϱ⠾î·Á¿î ºÎºÐÀÌ ÀÖ¾î ¿Ü±¹¿¡¼­´Â ¹«½¼ ¸»À» ÇÏ°í ÀÖ´ÂÁö ºÏ¹ÌÆó°æÇÐȸ »çÀÌÆ®(www.menopause.org)¸¦ ã¾Æº¸¾Ò½À´Ï´Ù. ¸í¿¹ ⸳ȸÀå À¯Æ¼¾È(Wulf H. Utian)ÀÇ ±ÛÀÌ Âü°í·Î ½Ç·Á Àִµ¥ ¾Æ·¡ ±× ³»¿ëÀ» ¼Ò°³ÇÕ´Ï´Ù. Àü¹® º¹»ç°¡ ¾î·Á¿ö(°­¹Ú»çÀÇ ½Ç·ÂÀ¸·Î) ÷ºÎÇÏÁö´Â ¸øÇß½À´Ï´Ù. 

2. ºÏ¹ÌÆó°æÇÐȸ ¸í¿¹ ȸÀå À¯Æ¼¾ÈÀÇ ±Û

À¯Æ¼¾ÈÀÇ ±ÛÀº ±×´ë·Î NIH ½ÃÇè °á°úÀÇ Çؼ³ÀÔ´Ï´Ù. ±×°÷¿¡´Â Prempro ´ë½Å¿¡  CEE(conjugated equine estrogens), MPA(medroxyprogesterone acetate)·Î ÇÏ¿© CEE+MPA ¶ó°í Çß½À´Ï´Ù. CEE+MPA HRT ¿ä¹ý¿¡ ´ëÇØ NIHÀÇ °á°ú¸¦ ´ÙÀ½°ú °°ÀÌ 6°¡Áö·Î Á¤¸®Çß½À´Ï´Ù.   

1) °ü»ó½ÉÀåÁúº´(CHD) Ä¡·á³ª ¿¹¹æ ¸ñÀûÀ¸·Î »ç¿ëÇÒ °¡Ä¡°¡ ¾ø´Ù.
2) ½É±Ù°æ»öÁõ, Á¤¸Æ Ç÷ÀüÁõ, Ç÷Àü»öÀüÁõÀÇ À§ÇèÀ» Áõ°¡½ÃŲ´Ù. ƯÈ÷ ¿ä¹ý ½ÃÀÛ 12-18°³¿ù ³»¿¡ ±×·¸´Ù. 
3) À¯¹æ¾ÏÀÇ ¾à°£ÀÇ Áõ°¡´Â °üÂû ¿¬±¸¿¡¼­ ¿¹ÃøÇß´ø, ¿¹¸¦ µé¾î 5³â ³» º¸´Ùµµ ÀÏÂï ÀϾ´Ù. Áõ°¡´Â 4³â° µÇ´Â ÇØ¿¡ Ư¡ÀûÀ¸·Î ³ªÅ¸³ª¸ç ±×ÈÄ ¹ß»ý °Ç¼ö´Â °¨¼ÒÇÏ´Â °æÇâÀ» º¸ÀδÙ. ÀÌ »ç½ÇÀº HRT°¡ Á÷Á¢ ¿øÀÎÀ̱⺸´Ù´Â ¼ºÀå ÃËÁøÀÇ ¿ªÇÒÀ» Çϱ⠶§¹®À¸·Î º¸ÀδÙ.
4) À§ÀÇ ¸ðµç È¿°ú´Â CEE¿¡ ´ëÇÑ °è¼ÓÀûÀÎ MPAÀÇ Áõ°­ È¿°ú¿Í °ü·Ã ÀÖ´Â °Í °°´Ù. CEE ´Üµ¶À¸·Î´Â ÀÌ·± È¿°ú°¡ ³ªÅ¸³ªÁö ¾Ê´Â´Ù. ÇöÀç Ç¥ÁØ ¿ë·®À¸·Î Àå±â°£ ¿ä¹ýÀÇ ¿ªÇÒÀº Áö±ØÈ÷ Àǽɽº·¯¿ï »ÓÀÌ´Ù. Àå±â ¿ä¹ýÀ» ÇÏ·Á¸é ÁÖ±â¿ä¹ý, ¿¹¸¦ µé¾î ¿¡½ºÆ®·Î°Õ¿¡ ´ëÇØ ¸Å 1-2°³¿ù¸¶´Ù ÇÁ·Î°Ô½ºÆ¾À» ÷°¡ÇØ ÁÖ´Â ¹æ¹ýÀÌ ÀûÀýÇÒ °ÍÀ̳ª ¾ÆÁ÷ ÀÔÁõµÈ °ÍÀº ¾Æ´Ï´Ù.
5) Ãʱ⿡ ´ëÅð°ñ °ñÀý°ú °áÀåÁ÷Àå¾ÏÀÇ °¨¼Ò ÇýÅÃÀ» º¸¿©ÁØ´Ù.
6) ¿¡½ºÆ®·Î°Õ  ´Üµ¶ÀÌ ¾ÆÁ÷Àº ÇýÅðú À§Ç輺ÀÇ ºñÀ² ¸é¿¡¼­ À¯¸®ÇÑ °ÍÀ¸·Î Áõ¸íµÇ¾ú´Ù.
   
¾Õ¼­ ¿ÍÀ̾µµ "´Ù¸¸ Àå±â°£ ó¹æÇÒ ÇÊ¿ä°¡ ÀÖÀ» °æ¿ì¿¡´Â À§Çè°ú ÀÌÁ¡À» °³º°ÀûÀ¸·Î Æò°¡ÇÒ °ÍÀ» ±Ç°íÇÑ"À̶ó´Â Ç¥ÇöÀ» ÇßÁö¸¸ ȯÀÚ °³°³Àο¡ ´ëÇÑ HRTÀÇ °¡Ä¡, °è¼ÓÀûÀÎ À§Çè°ú ÇýÅà Æò°¡´Â »õ·Î¿î °ÍÀÌ ¾Æ´Õ´Ï´Ù.  À¯Æ¼¾ÈÀº °ú°Å¿¡µµ °­Á¶µÆ°í À̹ø ÀÓ»ó °á°ú¸¦ ÅëÇØ °³º°È­°¡ ´õ¿í Áß¿äÇÏ°Ô µÆ´Ù°í ÇÕ´Ï´Ù. ÀÌ´Â Àå±â°£ ó¹æ¿¡¸¸ ÇÑÇÏ´Â °ÍÀÌ ¾Æ´Ï¶ó ´Ü±â ó¹æµµ ¸¶Âù°¡ÁöÀÔ´Ï´Ù.

¸¶Áö¸·À¸·Î À¯Æ¼¾ÈÀÇ ±Û¿¡¼­ ¹ß°ßÇÑ Áß¿äÇÑ ³»¿ëÀº Àå±â°£ ó¹æ°ú °ü·ÃÇÏ¿© "ÀÌÁ¦ 2³â ÀÌ»óÀÌ Àå±â ¿ä¹ýÀ¸·Î Á¤ÀǵƴÙ"¶ó°í Çß½À´Ï´Ù. À̹ø NIHÀÇ ÀÓ»ó ½ÃÇè °á°ú¿¡ ÀÇÇϸé ÀÌ·¸°Ô Á¤ÀÇÇØ¾ß ÇÑ´Ù´Â ¸»·Î ÀÌÇص˴ϴÙ. Á¦¹Ý ¹®Á¦ ´ëÇÑÆó°æÇÐȸÀÇ ÀÇ°ß°ú °ü·ÃÇÏ¿© ´Ù½Ã ¾ð±ÞÇÕ´Ï´Ù. 

3. º¹ÇÕ HRTÀÇ ÇýÅðú À§Çè¿¡ ´ëÇØ

´ëÇÑÆó°æÇÐȸ³ª ºÏ¹ÌÆó°æÇÐȸ´Â ÇÐÀÚµéÀÇ ¸ðÀÓÀ¸·Î º¸ÀÔ´Ï´Ù. ÀÌ´Â »êºÎÀΰú ÀÇ»çȸ¿Í °°Àº ÀÇ»çµéÀÇ ¸ðÀÓ°ú´Â ´Ù¸¨´Ï´Ù. ±×·³¿¡µµ À̵éÀÌ °øÅëÀûÀ¸·Î HRT ȯÀÚ¸¦ ¾È½É½ÃÄÑ¾ß ÇÑ´Ù°í »ý°¢ÇÏ´Â °ÍÀº ´ç¿¬ÇÕ´Ï´Ù. ƯÈ÷ »êºÎÀΰú ÀÇ»çȸ¿Í °°Àº Á÷Á¢ ȯÀÚ¸¦ Ä¡·áÇØ¿Â ÀÇ»ç·Î¼­´Â À̹ø NIHÀÇ ÀÓ»ó °á°ú¿¡µµ ºÒ±¸ÇÏ°í HRTÀÇ Á¤´ç¼ºÀ» À¯ÁöÇÏ·Á´Â ½É¸®°¡ ÀÛ¿ëÇÒ °ÍÀ¸·Î »ý°¢ÇÕ´Ï´Ù.

´ëÇÑÆó°æÇÐȸÀÇ ÀÇ°ßÀ̶ó´Â °ÍÀÌ ´ëºÎºÐ ¿Ü±¹ ´ÜüÀÇ ÀÇ°ßÀ» Á¶ÇÕÇßÀ» °ÍÀ̶ó°í ÃßÁ¤µË´Ï´Ù. ÀÌ ºÐ¾ß´Â ¹æ´ëÇϱ⠶§¹®¿¡ ÀüºÎ È®ÀÎÇÒ ¼ö´Â ¾ø°í ºÏ¹ÌÆó°æÇÐȸÀÇ À¯Æ¼¾ÈÀÇ ±ÛÀÌ ÀÓ»ó °á°úÀÇ Çؼ³·Î °¡Àå Á¤È®ÇØ º¸À̱⠶§¹®¿¡ ±× ±Û¿¡ ºñÃß¾î ´ëÇÑÆó°æÇÐȸÀÇ ÀÇ°ßÀÌ ¾î¶² °ÍÀÎÁö¸¸ ºÐ¼®ÇÏ·Á°í ÇÕ´Ï´Ù.   

Æó°æ ¿©¼º¿¡ ´ëÇÑ HRTÀÇ È¿´ÉÀº Prempro¿¡ ³ª¿Í ÀÖ´Â ´ë·Î "Æó°æ°ú °ü·ÃÀÌ ÀÖ´Â Ç÷°ü¿îµ¿¼º Áõ»ó, Áï È«Á¶, µµÇÑÀÇ Ä¡·á¿¡, Áú°ÇÁ¶ Ä¡·á¿¡ ±×¸®°í °ñ´Ù°øÁõ ¿¹¹æ"ÀÔ´Ï´Ù. ÈçÈ÷ HRT°¡ ÇÊ¿äÇÑ È¯ÀÚ¸¦ "Æó°æ Áõ»ó °³¼±°ú °ñ´Ù°øÁõ ¿¹¹æ"À̶ó°í ÇÏ´Â °ÍÀÌ ÀÌ°ÍÀÔ´Ï´Ù. º¹ÇÕ HRTÀÇ À§Çè°ú ÇýÅðú °ü·ÃÇÏ¿© ´ëÇÑÆó°æÇÐȸ´Â ´ÙÀ½°ú °°ÀÌ Àû¾î ³õ¾Ò½À´Ï´Ù. 

"WHI ¿¬±¸´Â pempro¸¦ 5³â°£ º¹¿ëÇÑ ¿©¼º¿¡¼­ ´ëÁ¶±º¿¡ ºñÇØ ¿¬°£ 10,000 ¸í´ç À¯¹æ¾ÏÀÌ 8 ·Ê, °ü»óµ¿¸ÆÁúȯ 7 ·Ê, ³úÁ¹Áß 7 ·Ê, Æó»öÀüÁõ 8 ·Ê°¡ ´õ ¹ß»ýÇÏ¿´°í, ´ëÀåÁ÷Àå¾ÏÀº 6 ·Ê, ´ëÅð°ñ °ñÀýÀº 5 ·Ê ´ú ¹ß»ýÇÏ¿´À¸³ª Àüü ¾ÏÀÇ ¹ß»ý ºóµµ¿¡´Â Â÷ÀÌ°¡ ¾ø¾ú´Ù°í º¸°íÇÏ¿´½À´Ï´Ù."

10,000¸í ´ç x ·Ê ½ÄÀ¸·Î º¸¾Æ ±× ¼ýÀÚ°¡ Å©Áö ¾Ê¾Æ º¸ÀÔ´Ï´Ù. ¶ÇÇÑ "Àüü ¾ÏÀÇ ¹ß»ý ºóµµ¿¡´Â Â÷ÀÌ°¡ ¾ø¾ú´Ù"¶ó°í ¾ÏÀ» ¸»ÇÑ °Íµµ ±×·¸½À´Ï´Ù. À¯Æ¼¾ÈÀº º¹¿ë±º°ú ´ëÁ¶±ºÀÌ "ÃÑ »ç¸Á·ü¿¡¼­ Â÷ÀÌ°¡ ¾ø´Ù"¶ó°í Ç¥ÇöÇß½À´Ï´Ù. ±×¸®°í ±× ¸î ·Ê¶ó´Â °ÍÀ» À¯Æ¼¾ÈÀÇ ´Ù¸¥ ½ÄÀ¸·Î º¸¸é ´ÙÀ½°ú °°½À´Ï´Ù. 

<À§Çè>
À¯¹æ¾Ï  10,000¸í´ç  Çöó½Ãº¸ 30 °Ç prempro 38 °Ç  26% Áõ°¡
°ü»ó½ÉÀåÁúº´ 10,000¸í´ç Çöó½Ãº¸ 30 °Ç prempro 37 °Ç  29% Áõ°¡??
³úÁ¹Áß 10,000¸í´ç Çöó½Ãº¸ 21 °Ç prempro 29 °Ç 41% Áõ°¡
Á¤¸ÆÇ÷ÀüÁõ 10,000¸í´ç Çöó½Ãº¸ 16 °Ç  prempro 34°Ç °ÅÀÇ 2¹è·Î Áõ°¡

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´ëÅð°ñ °ñÀý 10,000¸í´ç Çöó½Ãº¸ 15 °Ç prempro 10°Ç 33% °¨¼Ò
°áÀåÁ÷Àå¾Ï 10,000¸í´ç Çöó½Ãº¸ 16 °Ç prempro 10 °Ç 37% °¨¼Ò

NIH´Â ÀÌ ÀÚ·á·Î º¸¾Æ "À§ÇèÀÌ ÇýÅÃÀ» ¾ÐµµÇÑ´Ù"¶ó°í Çϸç ÀÓ»ó ½ÃÇèÀ» ÁߴܽÃŲ °ÍÀÔ´Ï´Ù. ±×¸®°í ¼ýÀÚ¸¦ º¸´Â ¹æ½ÄÀÔ´Ï´Ù. ¿©¼ºÀÌ À¯¹æ¾ÏÀ» ¿°·ÁÇÕ´Ï´Ù. ±×·±µ¥ ¼ýÀÚ·Î º¸¸é 10,000¸í´ç 30°ÇÀÌ ¹ß»ýÇß½À´Ï´Ù. À̸¦ ¿°·ÁÇÏ´Â °ÍÀÔ´Ï´Ù. ±×·±µ¥ HRT º¹ÇÕ ¿ä¹ý¿¡¼­´Â 38°ÇÀÌ ¹ß»ýÇß½À´Ï´Ù. 26%°¡ Áõ°¡Çß½À´Ï´Ù. ÀÌ´Â ºÐ¸íÈ÷ º¹ÇÕ HRTÀÇ ¹®Á¦¸¦ ³ªÅ¸³»´Â °ÍÀÔ´Ï´Ù.

´Ù¸¥ ½ÄÀ¸·Î º¾½Ã´Ù. Á¤È®ÇÑ ÀÚ·áÀÎÁö´Â ¸ð¸£³ª ½Å¹®¿¡ ±¹³» º¹ÇÕ HRT Ä¡·á ȯÀÚ°¡ 50¸¸¸í °¡·®À̶ó°í ÇÕ´Ï´Ù. ÀÌ È¯ÀÚ °¡¿îµ¥ Ä¡·á¿¡ ÀÇÇØ À¯¹æ¾Ï 400¸í, °ü»ó½ÉÀåÁúº´ 350¸í, ³úÁ¹Áß 400¸í, ±×¸®°í Á¤¸Æ Ç÷ÀüÁõ 900¸íÀÌ ¹ß»ýÇÏ´Â °ÍÀÔ´Ï´Ù. ÀÌ°ÍÀÌ ÀÛÀº ¼ýÀÚÀϱî¿ä? ´ëÇÑÆó°æÇÐȸ´Â ±×·³¿¡µµ Çѱ¹¿©¼º¿¡°Ô´Â ¹®Á¦°¡ ¾ø´Ù°í ³ªÅ¸³»·Á°í ÇÕ´Ï´Ù. ÀÌ·¸°Ô ÀûÇô ÀÖ½À´Ï´Ù. 

"À¯¹æ¾Ï ¹ß»ý À§ÇèÀÇ Áõ°¡´Â ¿¬±¸´ë»óÀÚ Àüü¿¡ ´ëÇÑ »ó´ëÀû ºñÀ²·Î¼­, ȯÀÚ °³ÀÎ´ç ¹ß»ý·üÀº ¿¬°£ 0.1% ¹Ì¸¸À̾ú´Âµ¥ ÀÌ´Â ¹Ì±¹ÀÇ Åë°èÀÌ°í ±¹³»ÀÇ °æ¿ì´Â À¯¹æ¾ÏÀÇ ¹ß»ý ºóµµ°¡ ¼­¾çÀÇ 1/4 - 1/6 Á¤µµÀÌ¸ç ¹ß»ý ¾ç»ó ¶ÇÇÑ ¼­¾ç¿¡¼­´Â 2/3°¡ 50´ë ÀÌÈÄ¿¡ ¹ß»ýÇÏ´Â ¹Ý¸é, ±¹³»¿¡¼­´Â 2/3°¡ 50´ë ÀÌÀü¿¡ ¹ß»ýÇϹǷΠÀÌ·¯ÇÑ ¿¬±¸ °á°ú¸¦ ±¹³»¿¡ ±×´ë·Î Àû¿ëÇϱ⿡´Â ¹«¸®°¡ ÀÖ½À´Ï´Ù."

´ëÇÑÆó°æÇÐȸ¿¡¼­ ±¹³» À¯¹æ¾Ï ¹ß»ý ºóµµ³ª ¿¬·É Åë°è¸¦ ¸»ÇÏ´Â °ÍÀÌ ±× Åë°è°¡ ¾ó¸¶³ª Á¤È®ÇÒÁö, ¾Ö½á ¹Ì±¹ÀÇ °á°ú¸¦ ±¹³»¿¡ Àû¿ëÇϱ⿡ ¹«¸®°¡ ÀÖ´Ù°í ÇÏ´Â ÀÌÀ¯°¡ ¹«¾ùÀÎÁö ÀÌ»óÇÏ°Ô »ý°¢µË´Ï´Ù.     

4. Prempro¿¡¸¸ ÇØ´çµÈ´Ù?

À¯»çÇÏ°Ô ´ëÇÑÆó°æÇÐȸÀÇ ¼ÒÀ§ ÀÇ°ß¿¡´Â À̹ø ÀÓ»óÀÌ Prempro¿¡¸¸ ÇØ´çµÈ´Ù´Â Àǹ̰¡ ¹ß°ßµË´Ï´Ù. À̵éÀº óÀ½ºÎÅÍ "ÇöÀç ó¹æµÇ°í ÀÖ´Â ¿¡½ºÆ®·ÎÁ¨/ÇÁ·ÎÁ¦½ºÅ×·Ð Á¦Àç´Â ±× Á¦Çü, ¼ººÐ ¹× Åõ¿©¹æ¹ýÀÌ ¸Å¿ì ´Ù¾çÇÕ´Ï´Ù"¶ó°í ÇÏ¸ç ´ÙÀ½°ú °°ÀÌ ¸»ÇÏ°í ÀÖ½À´Ï´Ù.

"Àú¿ë·® Á¢ÇÕ ¸¶ ¿¡½ºÆ®·ÎÁ¨°ú ¸Þµå·Ï½ÃÇÁ·ÎÁ¦½ºÅ×·Ð ¾Æ¼¼Å×ÀÌÆ® º´ÇÕ¿ä¹ý, ¼ººÐÀÌ ´Ù¸¥ ¿¡½ºÆ®·ÎÁ¨ ¹× ÇÁ·ÎÁ¦½ºÅ×·Ð º´ÇÕ¿ä¹ý, °æÇÇÅõ¿©¹ý µîÀÇ È¿°ú¿¡ Àû¿ëµÇ¾î¼­´Â ¾È µÈ´Ù°í º¾´Ï´Ù."

"È£¸£¸ó ´ëü¿ä¹ý Áß Á¢ÇÕ ¸¶ ¿¡½ºÆ®·ÎÁ¨°ú ¸Þµå·Ï½ÃÇÁ·ÎÁ¦½ºÆ®·ÎÁ¨ ¾Æ¼¼Å×ÀÌÆ® º´ÇÕ¿ä¹ý ¿Ü¿¡ ¿¡½ºÆ®·ÎÁ¨°ú ´Ù¸¥ ÇÁ·ÎÁ¦½ºÅ×·Ð º´ÇÕ¿ä¹ý, Àú¿ë·® È£¸£¸ó ´ëü¿ä¹ý, °æÇÇÅõ¿©¹ý µîÀº Áö¼ÓÀûÀ¸·Î »ç¿ëµÉ ¼ö ÀÖ½À´Ï´Ù."

À̹ø NIHÀÇ Prempro ½ÃÇèÀº ¿¡½ºÆ®·Î°Õ°ú ÇÁ·Î°Ô½ºÆ¾ º¹ÇÕ HRTÀÇ À§Çè°ú ÇýÅÃÀ» ÆǺ°ÇÏ·Á´Â °ÍÀ̾ú½À´Ï´Ù. ±×·±µ¥ ´ëÇÑÆó°æÇÐȸ´Â Prempro¸¦ Á¦¿ÜÇÑ ´Ù¸¥ º¹ÇÕ HRT´Â Áö¼ÓÀûÀ¸·Î »ç¿ëÀÌ °¡´ÉÇÏ´Ù°í ÁÖÀåÇÕ´Ï´Ù. ÀÌ ÁÖÀå¿¡ ¾î¶² ÀÌ·ÐÀû ÃßÁ¤ÀÌ ÀÖ´ÂÁö´Â ¸ð¸£³ª Áõ¸íµÇ¾ú´Ù°í º¸±â´Â ¾î·Æ½À´Ï´Ù. ¹®Á¦¸¦ ÇÇÇØ°¡·Á´Â ¹æ¹ýÀ̶ó´Â °­ÇÑ ÀλóÀ» ¹Þ½À´Ï´Ù.   

5. Àǻ翡 ´ëÇÑ ±Ç°í? 

´ëÇÑÆó°æÇÐȸ´Â "ÇöÀç È£¸£¸ó ´ëü¿ä¹ýÀ» ¹Þ°í ÀÖ´Â ¿©¼ºµéÀº µ¿¿äÇÏÁö ¸»°í ÁÖÄ¡ÀÇ¿Í »óÀÇÇϱ⸦ ±Ç°íÇÕ´Ï´Ù"¶ó°í Çϸç ÀÇ»çµé¿¡°Ôµµ ¿©·¯ °¡Áö¸¦ ±Ç°íÇß½À´Ï´Ù. ½ÃÇàÇϱâ Àü°ú ÈÄ¿¡ ½ÉÇ÷°ü Áúȯ ¶Ç´Â Ç÷ÀüÁõ º´·Â È®ÀÎ, À¯¹æ¾Ï °Ë»ç ¹× ÇÊ¿äÇÑ °Ë»ç¸¦ ½Ç½ÃÇ϶ó´Â °ÍÀº ´ç¿¬ÇÕ´Ï´Ù. ´ÙÀ½¿¡ ±Ç°í ³»¿ë Áß¿¡ ¹Ì½É½Àº ºÎºÐ¸¸À» ºÐ¼®ÇØ º¾´Ï´Ù.

"½ÉÇ÷°ü Áúȯ¸¸À» ¿¹¹æÇÒ ¸ñÀûÀ¸·Î Á¢ÇÕ ¸¶ ¿¡½ºÆ®·ÎÁ¨°ú ¸Þµå·Ï½ÃÇÁ·ÎÁ¦½ºÅ×·Ð ¾Æ¼¼Å×ÀÌÆ® º´ÇÕ¿ä¹ýÀ» »ç¿ëÇÏ´Â °ÍÀº °¡´ÉÇÑ ÇÇÇÒ °ÍÀ» ±Ç°íÇÕ´Ï´Ù."

À¯Æ¼¾ÈÀÇ ±Û¿¡´Â "°ü»ó½ÉÀåÁúº´(CHD) Ä¡·á³ª ¿¹¹æ ¸ñÀûÀ¸·Î »ç¿ëÇÒ °¡Ä¡°¡ ¾ø´Ù"¶ó°í µÅ ÀÖ½À´Ï´Ù. °¡Ä¡°¡ ¾ø´Â °ÍÀ» "°¡´ÉÇÑ ÇÇÇÒ °ÍÀ» ±Ç°íÇÑ´Ù"¶ó°í ÇÏ¿© "°¡´ÉÇÑ"À» ºÙÀÌ´Â ÀÌÀ¯°¡ ¾îµð¿¡ ÀÖ´ÂÁö ÀÌ»óÇÏ°Ô º¸ÀÔ´Ï´Ù. 

"Æó°æ±â Áõ»ó ¿ÏÈ­¿Í °ñ´Ù°øÁõ ¿¹¹æÀ» À§ÇÏ¿© ¿¡½ºÆ®·ÎÁ¨°ú ÇÁ·ÎÁ¦½ºÅ×·Ð º´ÇÕ¿ä¹ýÀ» ÇÒ °æ¿ì, Á¢ÇÕ ¸¶ ¿¡½ºÆ®·ÎÁ¨°ú ¸Þµå·Ï½ÃÇÁ·ÎÁ¦½ºÅ×·Ð ¾Æ¼¼Å×ÀÌÆ® º´ÇÕ¿ä¹ýÀº ´Ü±â°£ (¾à 4³â) ó¹æÇϽðí, Àå±â°£ ó¹æÇÏ¿©¾ß ÇÒ °æ¿ì´Â ÁÖ±âÀû Á¢ÇÕ ¸¶ ¿¡½ºÆ®·ÎÁ¨°ú ¸Þµå·Ï½ÃÇÁ·ÎÁ¦½ºÅ×·Ð ¾Æ¼¼Å×ÀÌÆ® º´ÇÕ¿ä¹ýÀ» ó¹æÇϰųª, ¸Þµå·Ï½ÃÇÁ·ÎÁ¦½ºÆ®·ÎÁ¨ ¾Æ¼¼Å×ÀÌÆ® ´ë½Å ÀÚ¿¬ ÇÁ·Î°Ô½ºÅ×·Ð ¶Ç´Â ¹Ì¼¼È­(micronized) ÇÁ·ÎÁ¦½ºÆ¾ µî ´Ù¸¥ ÇÁ·ÎÁ¦½ºÅ×·Ð Á¦Àç·Î ó¹æÇϽʽÿÀ."

ÀÌ ±ÛÀº ´Ü±â°£ ó¹æÀ» "¾à 4³â"À¸·Î Ç¥ÇöÇß½À´Ï´Ù. ±×·¯³ª ¾Õ¼­ À¯Æ¼¾ÈÀº À̹ø NIHÀÇ ÀÓ»ó ½ÃÇè °á°ú´Â "2³â ÀÌ»óÀÌ Àå±â°£À¸·Î Á¤ÀǵƴÙ"¶ó°í Çß½À´Ï´Ù. ½É±Ù°æ»öÁõ, Á¤¸Æ Ç÷ÀüÁõ, Ç÷Àü»öÀüÁõÀÇ À§ÇèÀÌ Æ¯È÷ ¿ä¹ý ½ÃÀÛ 12-18°³¿ù ³»¿¡ Áõ°¡ÇÑ´Ù°í ÇßÀ¸¸ç À¯¹æ¾Ïµµ ÀÌÀüÀÇ 5³âº¸´Ù´Â ºü¸¥ 4³â° µÇ´Â ÇØ¿¡ Ư¡ÀûÀ¸·Î Áõ°¡ÇÑ´Ù°í Çß½À´Ï´Ù. ±×¸®°í ´ëÅð°ñ °ñÀýÀ̳ª Á÷Àå°áÀå¾Ï °¨¼Ò ÇýÅÃÀº Ãʱ⿡ ³ªÅ¸³ª±â ¶§¹®¿¡ ÀÌ·± ¿©·¯ °¡Áö¸¦ °í·ÁÇÏ¿© Àå±â°£À» 2³â ÀÌ»óÀ¸·Î ¼öÁ¤ÇÑ °ÍÀ¸·Î »ý°¢µË´Ï´Ù.

µÞºÎºÐÀº Prempro ¿ÜÀÇ ´Ù¸¥ ó¹æÀº Àå±â°£ ó¹æÀ¸·Î »ç¿ëÀÌ °¡´ÉÇÏ´Ù´Â °ÍÀε¥ ¾Õ¼­ ¾ð±ÞÇÑ ºÎºÐÀÔ´Ï´Ù. ÀÌ Áß¿¡ "ÁÖ±âÀû Á¢ÇÕ ¸¶ ¿¡½ºÆ®·ÎÁ¨°ú ¸Þµå·Ï½ÃÇÁ·ÎÁ¦½ºÅ×·Ð ¾Æ¼¼Å×ÀÌÆ® º´ÇÕ¿ä¹ýÀ» ó¹æÇϰųª" ºÎºÐÀº À¯Æ¼¾ÈÀÇ "Àå±â ¿ä¹ýÀ» ÇÏ·Á¸é ÁÖ±â¿ä¹ý, ¿¹¸¦ µé¾î ¿¡½ºÆ®·Î°Õ¿¡ ´ëÇØ ¸Å 1-2°³¿ù¸¶´Ù ÇÁ·Î°Ô½ºÆ¾À» ÷°¡ÇØ ÁÖ´Â ¹æ¹ýÀÌ ÀûÀýÇÒ °ÍÀ̳ª ¾ÆÁ÷ ÀÔÁõµÈ °ÍÀº ¾Æ´Ï´Ù"¶ó°í ÇÑ ºÎºÐ°ú ºñ±³ÇÒ ÇÊ¿ä°¡ ÀÖ½À´Ï´Ù. ¾ÆÁ÷ Áõ¸íµÇÁö ¾ÊÀº ¹æ¹ýÀ» ±Ç°íÇÏ°í ÀÖ´Â °ÍÀÔ´Ï´Ù.

6. °á·Ð

¹Ì±¹¿¡¼­´Â ¿À·¡ ÀüºÎÅÍ HRT¿¡ ´ëÇÑ ³í¶õÀÌ Ä¡¿­Çß½À´Ï´Ù. ¿ì¸®ÀÇ °æ¿ì´Â °­³²Â÷º´¿ø ÀÌÁ¤³ë ±³¼ö¿Í °°Àº »ç¶÷ÀÌ HRT¸¦ ´ëº¯Çß°í ´ëÇÑÆó°æÇÐȸµµ ¿¬Àå¼±»óÀ̶ó°í »ý°¢µË´Ï´Ù. ´©°¡ ±ÕÇüÀ» Àâ¾Æ ÁÙÁö°¡ Áß¿äÇѵ¥, ºÒÇàÈ÷µµ ÀÇÇаè, ÀÇ»ç Áß ´©±¸°¡ HRT¸¦ ÀÚ½ÅÀÇ ½ÄÀ¸·Î ¸»ÇÏ´Â Áý´ÜÀÇ »ó´ë°¡ µÇ±â´Â ¾î·Á¿ö º¸ÀÔ´Ï´Ù. 

ÀÌ ±ÛÀ» Àû´Â °¡¿îµ¥ Çѱ¹ÀϺ¸ "¹Ú±ÝÀÚÀÇ ¼¼»óÀбâ"(2002³â 7¿ù31ÀÏ ¿ÀÈÄ 7:23, ¿©¼º È£¸£¸óÁ¦ À§ÇèÇÑ°¡, ¾Æ´Ñ°¡)¿¡¼­ ¹®Á¦ ÁöÀû ±ÛÀ» ¹ß°ßÇß½À´Ï´Ù. ¾Æ·¡ Àü¹®À» ÷ºÎÇß½À´Ï´Ù. ÀüüÀûÀ¸·Î ÀÌ ±ÛÀ» ÅëÇØ HRTÀÇ ¹®Á¦¿Í ³íÀïÀÇ ºÐÀ§±â¸¦ ÀÌÇØÇßÀ¸¸é ÇÕ´Ï´Ù. ³¡À¸·Î À̹ø NIHÀÇ ÀÓ»ó °á°ú°¡ ¿Ïº®ÇÑ °ÍÀÎÁöÀÇ ¹®Á¦µµ ÀÖÀ» ¼ö ÀÖÀ¸³ª ´ëü·Î ½Å·Ú¼ºÀÌ ÀÖ´Â °á°ú·Î ÀÎÁ¤ÇÏ´Â °ÍÀ¸·Î º¸ÀÔ´Ï´Ù.

..........................
July 15, 2002
Volume 80, Number 28
CENEAR 80 28 p. 8
 
PHARMACEUTICALS
HALTED ESTROGEN STUDY HITS WYETH
Higher risks cause NIH to pull plug on trial of the firm's major product

ANN THAYER

Confounding many long-held beliefs in the medical community, an NIH study has found that hormone replacement therapy involving estrogen and progestin can increase a woman's risk of breast cancer, heart attack, stroke, and blood clots. Believing that these risks outweigh the benefits found in reduced rates of bone fractures and colorectal cancer, NIH has ended the study.

About 6 million U.S. women take estrogen and progestin, largely for the relief of menopausal symptoms. The placebo-controlled study, to be published in the July 17 issue of the Journal of the American Medical Association, involved 16,608 women as part of the long-term Women's Health Initiative. A separate study of estrogen used alone is continuing.

Wyeth, which is a leading maker of hormone products and provided its Prempro combination therapy for the study, immediately informed physicians of the results. However, the company also suggested they consider patient needs for still using Prempro and "recognize the critical role combination HRT plays in treating the symptoms of menopause, the number one reason women start therapy."

Prempro makes up about 40% of Wyeth's Premarin family of hormone replacement products, sales of which grew a combined 11% in 2001 to more than $2 billion. According to IMS Health, Premarin was the third
most prescribed drug in the U.S.

Despite being a 60-year-old brand, Premarin and related products continue to be significant drivers of Wyeth's growth, accounting for about 20% of its drug sales last year. After learning of the study, Merrill Lynch, Standard & Poor's, and other analysts lowered their investment outlooks for Wyeth.

The company's stock plunged 24% to $37.30 per share on July 9, the day the study results were announced.

Chemical & Engineering News
Copyright ¨Ï 2002 American Chemical Society

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ÃÖ±Ù ¹Ì±¹ WHI (Women's Health Initiative, ¿©¼º°Ç°­¿¡ ´ëÇÑ ÁÖµµÀû ¿¬±¸)¿¡¼­ ¹ßÇ¥µÈ È£¸£¸ó ´ëü¿ä¹ý¿¡ °üÇÑ ¿¬±¸ °á°ú¿¡ ´ëÇÏ¿© ³í¶õ ¹× È¥µ·ÀÌ ÀÖÀ» ¼ö ÀÖÀ¸¹Ç·Î ÀÌ¿¡ ´ëÇÑÆó°æÇÐȸÀÇ ÀÔÀåÀ» ¾Æ·¡¿Í °°ÀÌ Ç¥¸íÇÏ´Â ¹ÙÀÔ´Ï´Ù.

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Menopausal Hormone Replacement Therapy
Date Last Modified: 08/2001
National Cancer Institute National Institutes of Health 

Concerns About HRT
Although HRT has potential benefits for many menopausal and postmenopausal women, it can also have drawbacks. Concerns about HRT center on the risk of endometrial cancer, ovarian cancer, and breast cancer, especially after long-term use (more than 10 years).

Endometrial Cancer (Cancer of the Uterus)
When estrogen replacement became available for menopausal women in the 1940s, it was administered in high doses without progestin. As it became more popular in the 1960s, it was given to increasing numbers of women. In the 1970s, however, it became clear that women who received estrogen alone had a six- to eightfold increased risk of developing cancer of the endometrium (lining of the uterus).

Now, most doctors prescribe HRT that includes progestin, along with much lower doses of estrogen than were used initially, for women who have not had a hysterectomy. Progestin counteracts estrogen's negative effect on the uterus by preventing the overgrowth of the endometrial lining. Adding progestin to HRT substantially reduces the increased risk of endometrial cancer associated with taking estrogen alone. (A woman who has had a hysterectomy does not need progestin and can receive HRT with estrogen alone.)

Ovarian Cancer
The results of past studies have not shown a clear link between HRT and the risk of ovarian cancer. However, recently reported data from two large, long-term studies have suggested that there may be an association between the use of HRT after menopause and an increased risk of ovarian cancer.

A study conducted by the American Cancer Society followed 211,581 postmenopausal women who had no history of cancer at the time of enrollment. Results of followup from 1982 through 1996 showed that women who used HRT for 10 or more years had an increased risk of dying from ovarian cancer, compared with women who had never used HRT or had used it for less than 10 years. Information on the type of HRT the participants used (such as estrogen-only or estrogen plus progestin) was not available. However, the majority of women using HRT at the beginning of the study probably used estrogen-only HRT.

Research conducted by the NCI as part of its Breast Cancer Detection Demonstration Project (BCDDP) Followup Study also examined the risk of ovarian cancer in postmenopausal women using HRT. The study followed 40,762 postmenopausal, cancer-free women from 1979 through 1998. The results suggested that estrogen-only HRT is associated with an increased risk of ovarian cancer when compared with HRT that includes progestin. More research is needed to clarify the relationship between HRT and the risk of ovarian cancer in postmenopausal women.

Breast Cancer
The relationship between HRT and breast cancer has not yet been completely clarified. The possible increased risk of developing breast cancer is consistently cited by menopausal and postmenopausal women as the main reason they are reluctant to use HRT. Many women and their doctors have particular concerns about the effects of long-term HRT use on breast cancer risk.

One of the most important risk factors for developing breast cancer is a woman's lifelong exposure to naturally occurring reproductive hormones, such as estrogen, because the longer her body produces these hormones, the more likely she is to develop breast cancer. Factors such as early menstruation (before age 12) and late menopause (after age 55) contribute to prolonged hormone exposure. Because of this relationship between prolonged hormone exposure and breast cancer risk, scientists have been concerned that increasing a woman's lifelong exposure to hormones with HRT would result in increased breast cancer risk.

Over the last 25 years, numerous observational studies have examined the possible relationship between HRT and breast cancer. These studies have varied widely in terms of study design; size of populations studied; and doses, timing, and types of hormones used. Results of these studies have been inconsistent. Some of the early studies that followed women who used estrogen-only HRT for long periods of time showed increased breast cancer risk. Other studies have looked at the experience of women who took estrogen combined with progestin. Some have shown an increased risk, while others have not.

A large study conducted by the Collaborative Group on Hormonal Factors in Breast Cancer showed an increased risk of developing breast cancer among current or recent HRT users. The researchers analyzed data from 51 studies on over 52,000 women with breast cancer and over 108,000 women without breast cancer. Their analysis indicated that the risk of developing breast cancer increases with the length of HRT use, but decreases after a woman stops taking HRT. They also found that, 5 years after discontinuing HRT, the elevation in a woman's risk of breast cancer had almost disappeared. Most of the women included in the study used estrogen-only HRT. The relationship of breast cancer risk and HRT that contains both estrogen and progestin is less certain; several other studies have focused on this relationship. Some have shown an increased risk, while others have not.

Two studies compared the risk of breast cancer for women who had taken estrogen-only HRT with the risk for women who had taken HRT using estrogen combined with progestin. The first study analyzed data on 46,000 women. The researchers found that the risk for breast cancer among women who had used HRT during the past 4 years was higher than the risk for women who did not use HRT. For women who had taken the combination HRT, the risk of breast cancer was 8 percent higher per year of HRT use. For women who had taken the estrogen-only therapy, the risk of breast cancer was 1 percent higher per year of HRT use. There was no increase in risk among women who had stopped using either type of HRT at least 4 years prior to the study.

The second study focused on nearly 1,900 postmenopausal women diagnosed with breast cancer and more than 1,600 controls matched for age, race, and neighborhood. The researchers found that, for combined HRT, the risk of developing breast cancer increased by 24 percent for every 5 years of use; for estrogen-only therapy, the risk increased by 6 percent every 5 years. Both studies reported that the increased risk of breast cancer associated with either type of HRT was more pronounced in thin women. More research is needed to test the effects of lower doses of HRT on the symptoms of menopause and breast cancer risk in thin women.

The results of these studies indicate that HRT containing both estrogen and progestin may have different effects on breast tissue than it does on ovarian tissue. Whereas combination HRT may be associated with a lower risk of ovarian cancer when compared with estrogen-only HRT, the opposite appears to be true for breast cancer risk.

The Postmenopausal Estrogen/Progestin Interventions (PEPI) trial was designed to study the effects of different HRT regimens in postmenopausal women. Data from the trial indicate that about 25 percent of women who use HRT that includes a combination of progestin and estrogen have an increase in breast density on their mammograms. In the PEPI study, about 8 percent of women taking estrogen-only HRT also had increased breast density. Increased density is a concern because other studies have shown that women age 45 and older whose mammograms show at least 75 percent dense tissue are at increased risk for breast cancer. However, researchers do not know if increased breast density due to HRT carries the same risk for breast cancer as having naturally dense breasts.

Increased breast density from HRT makes it more difficult for a radiologist to read some mammograms, sometimes leading to the need for followup mammograms and breast biopsies. One study showed that stopping HRT for about 2 weeks before having a mammogram improved the readability of the mammogram. However, further research is needed to confirm the usefulness of this approach.

There is also considerable uncertainty about the relationship between a woman's risk of developing breast cancer and the length of time she receives HRT. Some women take HRT for only a few years, until the worst of their menopausal symptoms have passed, while others take it for a decade or more. Some researchers believe that there is little or no increased risk of breast cancer associated with short-term use (3 years or less) of either HRT with estrogen alone or estrogen combined with progestin, while long-term use is linked to an increased risk.
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