Women’s health: Understanding hormone risk – National Consumers League

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Hormone health – whether related to health promotion, disease prevention, or optimal nutrition – is a critical issue for women and the health care providers who treat them. Issues such as hormone therapy, breast cancer prevention and treatment, and soy consumption are challenging health topics made more complicated by the ever-growing, and sometimes conflicting, information available to the public.  In this confusing environment, how do women and their health care providers access reliable information to make wise choices?

This question and others were explored at the National Consumers League’s Women’s Health Forum: Navigating Health Information, held on January 18, 2007 in Washington D.C., at the National Press Club. 

The forum provided attendees with background on these topics and explored how women and their health care providers must sift through vast amounts of often conflicting resources in order to find credible and reliable information. The American Nurses Association co-provided the forum and offered up to six hours of continuing education credit for nurses who attended. In addition to nurses, audience participants included other health care providers, consumer advocates, researchers, policy makers, and representatives from government and industry.

Tips for Identifying Reliable Resources

At the Women’s Health Forum, speakers and participants discussed the challenge of finding dependable information about the confusing and often controversial issues within women’s health. How’s a consumer to know whether what he or she is reading is trustworthy? The forum produced the following tips for judging the quality of health information:

1) When the resource includes information focusing on research for a specific medical treatment, consider the following:

  • What is the observed relative risk/benefit of the treatment, as well as the absolute risk/benefit? (See box below on the difference between absolute and relative risk) Are the findings statistically significant? Is this true for all populations or sub-groups evaluated?
  • Do the treatment studies have disease outcome results, or just surrogate markers?
  • If there is no evidence of harm or benefit available for the treatment, consider whether this is because the research findings are contradictory or not performed/available to the public; and
  • Is there a placebo effect – meaning that the patient’s symptoms are altered in some way (i.e., alleviated or exacerbated) by an otherwise inert treatment, due to the individual expecting or believing that it will work.

2) Always consider the source of information (does it appear in a peer-reviewed journal, or is it a sponsored white paper that has not undergone external scientific review?), the completeness of the research, and the financial ties of the source. Keep in mind that results from industry-sponsored studies are sometimes more favorable to that industry’s products than those conducted by independent third parties.

3) When reviewing health information, consider it in the context of your immediate concern (e.g., any symptoms you are trying to relieve or health conditions you want to treat now) AND your longer-term concerns (e.g., conditions or future health problems you are trying to avoid). Looking at the information in terms of both current and future health implications should help you make more informed and complete decisions.

Understanding risk

There are two main ways to talk about risk – relative risk and absolute risk.

Absolute risk refers to a person’s risk (or chance) of developing a disease over a certain time period.

Relative risk compares the risk of getting a disease in two different groups of people – such as a group taking medicine A compared to a group taking medicine B.

Although reports on new treatments often highlight the relative risk reduction of a treatment, the absolute risk gives a better sense of your individual risk. Both absolute and relative risk are important to consider, but relative risk can be misleading.

For Example:

Say 2 in 10,000 women risk developing cataracts by the time they are 70 years old. Research shows that a new treatment reduces the relative risk by 50%, meaning that a woman’s risk is reduced by half. In this example, the absolute risk of developing a cataract now falls from 2 in 10,000 women (.02%), to 1 in 10,000 women (.01%). A woman’s relative risk may be reduced by 50% with treatment, but a .02% absolute risk without treatment is still a pretty small risk.

This difference is particularly important for patients to consider when they look at the risks of particular treatments as well as benefits. If you have a very low absolute risk for a disease even before treatment, then the side effects associated with that treatment may not be worth the relative benefit you might get from taking it.