„Targeted invitations can markedly increase participation rates in cancer screening“—this was the conclusion of the authors of the article (1). The results continue to be sobering for women.
As a result of the written invitation, participation rates in screening colonoscopies rose from 4.5% to 6.2%. The authors list selection factors. The editorial points out that only 1.9% of those who had been sent a written invitation attended colonoscopy screening within the year's screening period. This is disappointing for women as bowel cancer is the third most common cancer-related cause of death in women. This means that postmenopausal women need a hormonal alternative.
The estrogen receptor beta (ER-beta) is known to have anti-proliferative and anti-inflammatory characteristics. The effects of these can be substantially increased by using ER-beta agonists, an approach that is already being used in bowel cancer therapy (2). In order for this approach to be successful, the need is for enough ER-beta, whose density decreases notably after the menopause as a result of prolonged estrogen deficiency. Hormone replacement immediately after the menopause can prevent such a receptor loss. The bowel mucosa benefits, thanks to the anti-proliferative and anti-inflammatory characteristics of the ER-beta, or, indirectly, from estrogen substitution, which protects against receptor loss.
The evidence is sound: the 2016 international guideline on hormone replacement points to hormonal bowel cancer prevention. A study reported by Long et al. (3) is cited, which reports a halved risk (relative risk 0.47) after 9–14 years of hormone replacement. This preventive potential can be used as one of many co-indications; the risk for healthy women is very low. The negative reports of the Women's Health Initiative (WHI) on hormone replacement therapy since 2002 are now history. After 14 years, the 2016 WHI study initiators apologized for an incorrect evaluation and unnecessary scaremongering (4).
In conclusion: the effort involved in increasing screening participation rates should be balanced by providing hormonal bowel cancer prevention.
References
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