WHITE SULPHUR SPRINGS, W. VA. — Most physicians who prescribe hormone therapy still overestimate both its long-term risks and benefits, R. Stan Williams, M.D., said at the annual meeting of the South Atlantic Association of Obstetricians and Gynecologists.
Compared with internists and family doctors, ob.gyns. were the most likely to display an accurate understanding of these issues. But a large portion still gave incorrect answers to Dr. Williams' physician survey on hormone therapy (HT).
“These people thought they understood the results of the Women's Health Initiative [WHI] and said they were counseling their patients about it, but only 28% of their answers were correct,” said Dr. Williams, professor of ob.gyn. at the University of Florida, Gainesville, and chief of the university's division of reproductive endocrinology and infertility. “Most respondents (67%) dramatically overestimated the risks and benefits,” and 5% of the answers “were actually in the wrong direction—they thought it was a risk when it was a benefit.”
In March 2004, Dr. Williams mailed his survey to all primary care physicians in Florida. The survey asked a specific question about the percentage of annual attributable change of risk of heart disease, stroke, venous thrombosis, breast cancer, colon cancer, hip fracture and death, as reported in the WHI. He sent out more than 6,000 surveys; 600 were returned (203 from ob.gyns., 145 from internists, 219 from family physicians, and 33 from other physicians).
About 35% of ob.gyns., 30% of family physicians, and 17% of internists correctly answered that HT increased the risk of heart disease by less than 1% per year of use. Many thought there was no change in risk (35% of internists, 33% of ob.gyns., and 27% of family physicians). About 20% of internists and 15% of family physicians said the risk rose 10%-30% per year of use.
About 50% of ob.gyns., 35% of internists, and 30% of family physicians correctly answered that HT increased the risk of stroke by less than 1% per year of use. About 20% of family physicians, 17% of internists, and 15% of ob.gyns. said the increased risk was 10%-30% per year of use.
About 50% of ob.gyns., 30% of internists, and 27% of family physicians correctly answered that HT increases the risk of venous thrombosis by less than 1% per year of use. About 30% of ob.gyns., 25% of internists, and 30% of family physicians said the risk was increased by 10%-30% per year of use.
About half of ob.gyns., half of family physicians, and 40% of internists correctly answered that HT increases the risk of breast cancer by less than 1% per year of use. About 17% of internists, 15% of family physicians, and 8% of ob.gyns. said the increased risk was 10%-30% per year of use.
The benefits of HT also were misunderstood. Only about 35% of ob.gyns., 20% of internists, and 17% of family physicians correctly answered that the breast cancer risk fell about 1% per year of use.
Most internists (70%) and family physicians (55%) and 30% of ob.gyns. said HT did not change the risk of colon cancer. Only 20% of ob.gyns., 18% of family physicians, and 20% of internists correctly answered that the risk fell 1% per year of use.
About 17% of ob.gyns., 15% of internists, and 10% of family physicians correctly answered that HT decreases the risk of osteoporotic hip fracture by 1% per year of use. About 60% of internists, 55% of ob.gyns., and 50% of family physicians thought the risk reduction was 10%-30% per year of use.
Most respondents understood that there is no change in overall mortality rates associated with HT use. About 85% of ob.gyns. and 65% of internists and family physicians answered correctly. But a few respondents said the overall mortality risk increased 3%-10% per year of use.
Dr. Williams also asked respondents' views of HT on a scale of 1–5, with 5 being positive. The average rating was 3.89 among ob.gyns., 3.0 among family physicians, and 2.7 among internists.
Last year, he presented results of a similar survey he conducted among 1,000 women aged 45–65, which showed that up to 36% believed their attributable risk of heart disease and stroke was 10%-30% per year of HT use. More than half believed the breast cancer risk was 10%-30% per year of HT, and 60% believed HT could reduce the risk of osteoporotic hip fracture by up to 30% per year.