[Is the clinical profile of women treated with tibolone similar to that of women receiving a classical estrogen-progestogen therapy? Data from a nationwide survey in France].
OBJECTIVE
To compare the pre-existing risk profiles for breast or endometrial cancer of menopaused women receiving tibolone or another hormone replacement therapy in France, with a view to examining the possibility of biases of selection of patients and of detection of these cancers in the Million Women Study.


METHODS
Nationwide survey conducted in France among a representative sample of 153 gynaecologists. The particulars of the last two consulting menopaused women treated with tibolone (N = 306) and of the last two treated with a classical estrogen-progestogen therapy (N = 306) were collated then analysed.


RESULTS
Compared to those treated with a classical estrogen-progestogen therapy, more women receiving tibolone were aged 60 years or over (40 vs 31%; P < 0.01). More of them had risk factors for breast cancer (history of mastodynia or mastopathy, elevated mammographic breast density) (6 vs 50%; P < 0.01). More of them had a history of uterine investigation or exploration or of irregular bleeding (61 vs 53% of women with a history of irregular bleeding; P < 0.05). Overall, 84% of women treated with tibolone had at least one risk factor for breast or endometrial cancer vs 75% of those receiving a classical estrogen-progestogen therapy (P < 0.01).


CONCLUSIONS
Owing to its specific properties, tibolone is generally prescribed to women with a higher risk profile for breast or endometrial cancer than those receiving a classical estrogen-progestogen therapy, which may entail patient selection and cancer detection biases in non-randomised, open-label, observational studies.
Jamin
C
C
Service de gynécologie-obstétrique, maternité Aline-de-Crépy, CHU Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France. ch.jamin@laposte.net
Bourg
F
F
Legeai
J
J
Senoussi
S
S
D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000209:etiology; D016889:Endometrial Neoplasms / Q000453:epidemiology* / Q000209:etiology; D020847:Estrogen Receptor Modulators / Q000494:pharmacology*; D015914:Estrogen Replacement Therapy; D005260:Female; D005602:France / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D008875:Middle Aged; D009652:Norpregnenes / Q000494:pharmacology*; D017698:Postmenopause; D012307:Risk Factors; D015983:Selection Bias
D020847:Estrogen Receptor Modulators; D009652:Norpregnenes; C027385:tibolone