Depo-Provera is an injection used to prevent pregnancy. It is also used to treat endometriosis. The drug is in a class of medications called progestins that work to prevent pregnancy by preventing ovulation and thinning the lining of the uterus. It is administered through injection into the upper arm or buttocks, and is usually given once every three months by a health care provider in an office or clinic.

The updated Warnings and Precautions section warns women who currently have or have had breast cancer to not use hormone contraceptives, such as Depo-Provera, because breast cancer may be hormonally sensitive. Women with a strong family history of breast cancer or who have breast nodules should be monitored with particular care. Hormone therapy has long been a health concern for women. A massive government-funded study on menopausal and postmenopausal established in 2001 a strong connection between combined estrogen and progestin hormone replacement therapy and breast cancer risk.

The Warnings and Precautions section also includes a warning that the drug may decrease the amount of calcium stored in the bones of patients who use the drug. The longer the medication is taken, the more the amount of calcium in the bones may decrease. Even after the drug has been discontinued, the amount of calcium in the bones may not return to normal. This calcium loss in the bones may cause osteoporosis and may increase users’ risk of bone breaks, especially after menopause.

SOURCE: Hormone Replacement Therapy › Depo-Provera’s new label warns of breast cancer, bone density loss

This week, Pfizer, which recently acquired Wyeth, the makers of the hormone replacement therapies (HRT) Prempro and Premarin, were hit with more than $100 million in two punitive-damage awards from Philadelphia juries. The two plaintiffs, Connie Barton and Donna Kendall, claimed the drugs caused their breast cancer.

The evidence was startling. Plaintiffs attorneys proved that Wyeth launched a massive campaign to push the benefits of its HRT drugs to doctors and the general public while knowingly dismissing or downplaying other institutes’ data that revealed an increased risk of breast cancer with the use of combination hormone therapy. The company went to such lengths as to hire ghostwriters to write articles for reputable medical journals that minimized the breast cancer risk and exaggerated the benefits of HRT.

It wasn’t until the government-initiated Women’s Health Initiative (WHI) that everything changed. WHI was a 15-year study launched in 1991 that aimed to address the most common causes of death, disability and poor quality of life in postmenopausal women, including cardiovascular disease, cancer and osteoporosis. In 2002, WHI halted the estrogen-plus-progestin trial after investigators found that the associated health risks of the combined hormone therapy out weighted the benefits. The 2002 report showed there was a 24 percent increase in the risk for breast cancer due to estrogen-plus-progestin HRT.

Since then, more than 10,000 other product liability suits have been filed over the HRT drugs in across the country, 1,500 of which have been filed in the Philadelphia court. Many of the cases are filed in Philadelphia because Wyeth’s headquarters were located there.

“Wyeth had no concern whatsoever for the health of the patients. They were only concerned about their profits,” says Michael Richmond, a jury foreperson in a Prempro trial.

Sales of Prempro and Premarin exceeded $2 billion a year before 2002. Last year, $1.4 billion in estrogen drugs and $400 million in estrogen-progestin combination drugs were sold in the United States.

More Information
HRT Jury Verdict Chart

Sources:
Beasley Allen Law Firm
New York Times

SOURCE: Hormone Replacement Therapy › Two breast cancer survivors awarded $100 million in HRT lawsuits

The study published this week in the Epidemiology journal refutes the notion that a family history contributes to the carcinogenic effects of estrogen.

“Although we know that family history is a risk factor, we don’t know yet what it is about family history that conveys the risk,” said Robert E. Gramling, M.D., D.Sc., assistant professor of Family Medicine and of Community and Preventive Medicine at URMC. “Some have proposed that it might be an increased sensitivity to estrogen, but our data did not support that notion. In fact, this study suggests the causal pathway based on family history is probably not estrogen sensitivity.”

Family history is identified as a “first-degree family history,” involving breast cancer in a mother, sister or daughter. Both family history and estrogen therapy have independently been identified as a risk factor for postmenopausal women. The Rochester study focused on whether the two risk factors together increased a woman’s risk.

Researchers used data from the Women’s Health Initiative randomized trial, which followed 16,608 premenopausal women who took HRT or a placebo pill between 1993 and 2002. The study was halted after data began to show that HRT greatly increased a woman’s risk of breast cancer, heart disease and other serious illness.

SOURCE: Hormone Replacement Therapy › HRT-breast cancer risk same regardless of family history

Bone scans are used to check for osteoporosis, a disease in which bones become fragile and more likely to break. Women are typically four times more likely than men to suffer from osteoporosis. Because there is a direct relationship between the lack of estrogen after menopause and the development of osteoporosis, most doctors advise older women to have bone density tests every year along with a mammogram.

The University of Arizona’s eight-year study of 10,000 post-menopausal women found that the results of a routine bone density test not only could reveal osteoporosis, it also may provide important clues in predicting breast cancer risk in older, post-menopausal women. The study, which looked at hip-bone mineral density T-score, found older women with high bone density twice as likely to develop breast cancer.

“High bone density is a marker of increased risk for breast cancer. We can use that piece of information to predict your breast cancer risk in the future,” said Zhao Chen, Ph.D, MPH, University of Arizona epidemiologist.

Bone density often means a higher production of estrogen, which researchers say may explain the correlation between high bone density and breast cancer risk.

Conversely, KABC-TV reports that some osteoporosis medications have been shown to prevent and even curtail breast cancer. For example, raloxifene (Evista) has already been FDA approved to treat both osteoporosis and prevent breast cancer in postmenopausal women at high risk of developing the disease.

SOURCE: Hormone Replacement Therapy › Strong bones in menopause may increase risk of breast cancer

Earlier this week, as part of October’s international breast cancer awareness month, leaders from Liaquat National Hospital in Pakistan addressed the issue and their concern over why so many Pakistani women are still unaware of the disease, according to the Daily Times.

Sixty-eight percent of Pakistani women living in urban areas have breast cancer as opposed to 32 percent of Pakistani women living in rural areas. Oncologists blame the lack of awareness and information about the treatment for breast cancer, citing women’s concern that chemotherapy causes hair loss and biopsies will help the disease spread. They also argue that free mammograms would encourage more women to seek medical attention and thus aid in early detection.

According to the story, 10 percent of Pakistani women are at risk for breast cancer, but few are aware of the risk factors for the disease.

Aga Khan University Hospital Associate Professor of Haematology and Oncology, Dr Nihal Masood, in her lecture on at the conference said that there is a greater than 50 percent spread of breast cancer in the country for younger women. “Therefore, every doctor, medical student and informed people should convey this message to elder women of their families so they are examined,” according to the report.

SOURCE: Hormone Replacement Therapy › Pakistani women still unaware of breast cancer risk

Researchers analyzed data from 38 observational studies involving more than 2.7 million women to see whether taking non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, reduced risk of breast cancer. Inflammation may be a risk factor in cancer, the report says.

Earlier studies on NSAIDS in reducing breast cancer risk have shown conflicting results. Reviewers hope that by combining results they may identify trends that individual studies may miss.

NSAIDs work through the suppression of estrogen, which has researchers speculating that the use of NSAIDs may reduce the risk of hormone-positive breast cancer. Hormone-positive breast cancer, also referred to as estrogen receptor (ER)-positive breast cancer, is the most common type of breast cancer and is stimulated to grow from exposure to the female hormones estrogen and/or progesterone, according to the Daily Cancer News –CancerConsultants.com.

According to the report, women who regularly took any type of NSAIDs had a 12 percent reduction of breast cancer risk. While the news is promising, the report urges that women should first consult their healthcare provider before using any NSAIDs, as these medications can have side effects that carry risks that outweigh the benefits against breast cancer.

SOURCE: Hormone Replacement Therapy › anti-inflammatory drugs may reduce breast cancer risk

A study published in the January issue of Cancer Epidemiology, Biomarkers and Prevention found that women who used combination hormone therapy for three or more years had a higher risk of lobular cancer.

The study was led by Dr. Christopher Li of the Fred Hutchinson Cancer Research Center and was designed to evaluate the relationship between combination hormone therapy and lobular breast cancers. Previous research indicated that five or more years of combined hormone therapy use was necessary to increase overall breast cancer risk. The study led by Dr. Li found that women who took combined hormone therapy for three years or more had four times the usual risk of lobular breast cancer.

The incidence of invasive lobular cancer rose by 52% in the United States between 1987 and 1999, and cases of ductal-lobular breast cancer rose by 96% during that time. According to Dr. Li, their research “suggests that the use of post-menopausal hormone-replacement therapy, specifically the use of combined estrogen-plus-progestin preparations, may be contributing to this increase.” Following the announcement of the results of the Women’s Health Initiative in July 2002, hormone therapy use fell sharply.

The incidence of breast cancer dropped more than 8% between 2001 and 2004. Beasley Allen law firm has been involved in extensive litigation dealing with hormone therapy and breast cancer. We are convinced that there will be more litigation in this area of concern. Ted Meadows and Melissa Prickett from our firm are handling cases for clients at this time.

SOURCE: Hormone Replacement Therapy › Hormone therapy update

The jury also must decide whether Wyeth failed to adequately test their drugs Premarin, an estrogen replacement, and Prempro, a combination estrogen and progestin, before putting them on the market and whether it failed to warn doctors about the drugs’ risks.

“Wyeth didn’t do (breast cancer) studies because the results could be embarrassing and could be costly,” Zoe Littlepage, a lawyer for Jeraldine Scofield of Fallon, Arlene Rowatt of Incline Village and Pamela Forrester of Yerington, told the jury.

The company’s decision to produce, market and sell a dangerous product affected thousands of women, and the company should be held responsible, Littlepage said during her closing argument in Washoe District Court.

Wyeth lawyer Heidi Hubbard said microscopic analysis showed the cancers each of the three women suffered are different, and no one can say why they developed. But each woman had a list of risk factors that could have contributed to their diseases.

“So many women get breast cancer, and we don’t know to this day what causes it; and researchers are trying to find the cause so they can find the cure,” Hubbard said.

“This case is about a medication that’s an appropriate treatment option for many women,” she said. “To this day, (the drugs) are the most effective available for menopausal symptoms.”

Scofield, 75, Rowart, 67, and Forrester, 64, began taking hormone replacement drugs years ago to offset hot flashes and other discomforts associated with menopause. But when each developed breast cancer, they stopped the drugs and underwent treatment.

The lawyers for the three women, who have sat in the front row of the courtroom every day of the trial, said Wyeth knew there were links between their drugs and the cancers but ignored the dangers in favor of skyrocketing sales.

The warning labels the company put on the drugs sounded more like reassurances than alarms, Littlepage said. Doctors testified if they knew then what they know now about the breast cancer risks, they never would have prescribed the drugs long-term as the company promoted them, she said.

Dan Webb, another Wyeth lawyer, challenged those claims.

Wyeth helped sponsor or participated in 63 studies to look at whether hormone replacement drugs increased the risk of breast cancer, he said. When the results came in, the company followed a directive from the U.S. Food and Drug Administration and created warning labels that detailed the risks, he said.

“The FDA knows more about research on drugs than the plaintiffs,” Webb said. “When (the women) say we didn’t properly test, it’s not true. Wyeth clearly understood the breast cancer risk and put it on the label.”

The women’s civil lawsuit seeks unspecified damages, but Littlepage told the jurors that they should look at how the company spent its money to promote the drugs when considering an appropriate amount. Those totals were in the millions of dollars.

October 10th, 2007

SOURCE: Hormone Replacement Therapy › Prempro lawsuit goes to the jury

Brett Hendricks, a former sales representative for Wyeth, provided riveting testimony regarding his twenty-one year career with the largest manufacturer of hormone replacement therapy drugs that outlined the organized deception of doctors and patients that plaintiffs contend overstated the benefits of HRT therapy while concealing the risks.

“That’s how we were trained,” Hendricks said. “To offset any bad publicity, we would redirect and emphasize the benefits of the product and say the benefits far outweighed any problems that might be out there.”

On the stand, Hendricks confirmed Wyeth’s marketing strategy that had already been laid out in the millions of pages of documents produced by Wyeth and others in the HRT litigation that has been pending for more than five years. Wyeth sales representatives were encouraged to engage in aggressive, one-on-one sales tactics with prescribing physicians to supplement the manufacturer’s advertising plan which included overselling the benefits of HRT drugs, discrediting scientific studies that raised any questions about safety (especially breast cancer risks), criticizing physicians who chose safer alternative drugs or counseled their patients on the option of not taking any HRT drugs at all, and pushing menopausal women to take combination hormone product drugs from the onset of menopause (or perhaps even before) and to continue taking the drugs throughout the rest of their lives.

In July of 2002, the Women’s Health Initiative (“WHI”) study was published and confirmed what many had long suspected – that Prempro and combination hormone replacement products (including Wyeth’s Premarin taken in combination with Pfizer’s Provera or another progestin such as medroxyprogesterone) are associated with an increased risk of hormone-positive breast cancers as well as other health risks, including heart attacks, strokes, blood clots, and ovarian cancer, etc.

The WHI Study (which was funded by the United States government, after manufacturers of hormone replacement drugs failed to conduct proper studies to evaluate the risks of HRT-induced breast cancer) led to a fundamental shift in the manner in which HRT drugs were prescribed. Today, physicians and patients are being told that HRT is not right for every woman, and instead should only be considered by those for whom the symptoms of menopause are severe and interfering with their lives. In addition, patients have been encouraged to use HRT drugs for the shortest time possible and at the lowest possible doses.

In fact, the Prempro product ingested by most women prior to 2002 no longer exists, and instead was replaced by a lower dose product (although it is not yet known whether a lower dose actually equates to a lower breast cancer risk). There is also a strong movement in the medical community to investigate other drugs for menopausal symptoms and osteoporosis, including SERMs (selective estrogen receptor modulators) and natural or bioidentical hormones that more closely resemble those that are made by a woman’s body. Prempro, for example, includes an estrogen compound derived from the urine of pregnant horses and chemically synthesized progestin (which is a necessary additive since estrogen alone has long been known to cause uterine cancer, but also eliminates many of the benefits that have been shown with use of estrogen alone and increases the risks of breast cancer).

The pharmaceutical industry has long maligned alternative therapies for menopausal patients, but evidence continues to mount that the HRT-induced breast cancer epidemic noted in recent breast cancer registries might have been avoided if women had been given more information in order to make meaningful decisions regarding treatment options years ago.

The Reno HRT trial is expected to last for a few more weeks. Alley, Clark, Greiwe & Fulmer will be trying the first HRT case in Florida in Pinellas County in June of 2008. This will be the first wrongful death claim to be brought to trial in the national litigation. The case was brought on behalf of a Clearwater grandmother who was diagnosed in early 2002 at the age of 59 with hormone-positive lobular breast cancer (the type most strongly associated with use of HRT drugs), just months prior to announcement of the WHI study results. Her cancer was very aggressive and had already spread to brain and bones by that time. After fighting valiantly for several years, she lost her battle and died late last year before her case was scheduled for trial. The lawsuit is now being prosecuted by her loving husband of forty-one years on behalf of her estate and survivors.

October 5th, 2007

SOURCE: Hormone Replacement Therapy › HRT sales rep whistleblower admits improper promotion