***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: CONTEXT The Women 's Health Initiative trial of combined estrogen plus progestin was stopped early when overall health risks , including invasive breast cancer , exceeded benefits . Outst and ing issues not previously addressed include characteristics of breast cancers observed among women using hormones and whether diagnosis may be influenced by hormone effects on mammography . OBJECTIVE To determine the relationship among estrogen plus progestin use , breast cancer characteristics , and mammography recommendations . DESIGN , SETTING , AND PARTICIPANTS Following a comprehensive breast cancer risk assessment , 16 608 postmenopausal women aged 50 to 79 years with an intact uterus were r and omly assigned to receive combined conjugated equine estrogens ( 0.625 mg/d ) plus medroxyprogesterone acetate ( 2.5 mg/d ) or placebo from 1993 to 1998 at 40 clinical centers . Screening mammography and clinical breast examinations were performed at baseline and yearly thereafter . MAIN OUTCOME MEASURES Breast cancer number and characteristics , and frequency of abnormal mammograms by estrogen plus progestin exposure . RESULTS In intent-to-treat analyses , estrogen plus progestin increased total ( 245 vs 185 cases ; hazard ratio [ HR ] , 1.24 ; weighted P<.001 ) and invasive ( 199 vs 150 cases ; HR , 1.24 ; weighted P = .003 ) breast cancers compared with placebo . The invasive breast cancers diagnosed in the estrogen plus progestin group were similar in histology and grade but were larger ( mean [ SD ] , 1.7 cm [ 1.1 ] vs 1.5 cm [ 0.9 ] , respectively ; P = .04 ) and were at more advanced stage ( regional/metastatic 25.4 % vs 16.0 % , respectively ; P = .04 ) compared with those diagnosed in the placebo group . After 1 year , the percentage of women with abnormal mammograms was substantially greater in the estrogen plus progestin group ( 716 [ 9.4 % ] of 7656 ) compared with placebo group ( 398 [ 5.4 % ] of 7310 ; P<.001 ) , a pattern which continued for the study duration . CONCLUSIONS Relatively short-term combined estrogen plus progestin use increases incident breast cancers , which are diagnosed at a more advanced stage compared with placebo use , and also substantially increases the percentage of women with abnormal mammograms . These results suggest estrogen plus progestin may stimulate breast cancer growth and hinder breast cancer diagnosis PURPOSE / OBJECTIVES To compare the hot flash symptom experience and related outcomes between breast cancer survivors and healthy women . DESIGN Descriptive , cross-sectional , comparative study . SETTING Southeastern university medical center . SAMPLE 69 of 207 breast cancer survivors contacted via a tumor registry and 63 age-matched healthy female volunteers . Survivors were a mean of 57 years and a mean of 39 months postdiagnosis . METHODS Mailed survey included a demographic , disease , and treatment information form ; a gynecologic history form ; a two-day , prospect i ve , hot flash diary ; a detailed hot flash question naire ; mood and affect scales ; and the Hot Flash-Related Daily Interference Scale . MAIN RESEARCH VARIABLES Hot flashes , mood , affect , interference with daily activities , and overall quality of life . FINDINGS Breast cancer survivors had hot flashes that were significantly more frequent , severe , distressing , and of greater duration . Breast cancer survivors were less likely to be using hormone replacement and more likely to have tried nonhormonal prescription interventions in the past , but reported significantly less effectiveness from hot flash treatments . Breast cancer survivors with severe hot flashes reported significantly greater mood disturbance ; higher negative affect ; more interference with daily activities , including sleep , concentration , and sexuality ; and poorer overall quality of life in comparison to breast cancer survivors with no hot flashes to mild hot flashes . Hot flash quality and triggers were not significantly different between groups . No clear temporal pattern of hot flashes emerged . CONCLUSIONS Hot flashes are a significant problem for breast cancer survivors , even for those who are naturally postmenopausal ( i.e. , did not undergo menopause as a result of surgery or the effects of chemotherapy ) . Hot flashes remained fairly stable over time and did not diminish in frequency , severity , or associated distress . IMPLICATION S FOR NURSING The findings guide the assessment of the uniqueness of the problem of hot flashes experienced by breast cancer survivors and help define outcomes to address in clinical practice or include in future hot flash intervention research In the 1990s , two r and omised clinical trials started in Sc and inavia addressing whether hormone replacement therapy ( HRT ) is safe for women with previous breast cancer . We report the findings of the safety analysis in HABITS ( hormonal replacement therapy after breast cancer -- is it safe ? ) , an open r and omised clinical trial with allocation to either HRT or best treatment without hormones . The main endpoint was any new breast cancer event . All analyses were done according to intention-to-treat . Until September , 2003 , 434 women were r and omised ; 345 had at least one follow-up report . After a median follow-up of 2.1 years , 26 women in the HRT group and seven in the non-HRT group had a new breast-cancer event . All women with an event in the HRT group and two of those in the non-HRT group were exposed to HRT and most women had their event when on treatment . We decided that these findings indicated an unacceptable risk for women exposed to HRT in the HABITS trial , and the trial was terminated on Dec 17 , 2003 PURPOSE To determine whether estrogen replacement therapy ( ERT ) alters the development of new or recurrent breast cancer in women previously treated for localized breast cancer . PATIENTS AND METHODS Potential participants ( n = 319 ) in a trial of ERT after breast cancer were observed prospect ively for at least 2 years whether they enrolled onto the r and omized trial or not . Of 319 women , 39 were given estrogen and 280 were not given hormones .  Tumor size , number of lymph nodes , estrogen receptors , menopausal status at diagnosis , and disease-free interval at the initiation of the observation period were comparable for the trial participants ( n = 62 ) versus non participants ( n = 257 ) and for women on ERT  ( n = 39 ) versus controls ( n = 280 ) . Cancer events were ascertained for both groups . RESULTS Patient and disease characteristics were comparable for the trial participants versus non participants , as well as for the women on ERT versus the controls . One patient in the ERT group developed a new lobular estrogen receptor-positive breast cancer 72 months after the diagnosis of a ductal estrogen receptor-negative breast cancer and 27 months after initiation of ERT . In the control group , there were 20 cancer events : 14 patients developed new or recurrent breast cancer at a median time of 139.5 months after diagnosis and six patients developed other cancers at a median time of 122 months . CONCLUSION ERT does not seem to increase breast cancer events in this subset of patients previously treated for localized breast cancer . Results of r and omized trials are needed before any changes in current st and ards of care can be proposed BACKGROUND Hormone replacement therapy ( HRT ) is typically avoided for women with a history of breast cancer because of concerns that estrogen will stimulate recurrence . In this study , we sought to evaluate the impact of HRT on recurrence and mortality after a diagnosis of breast cancer . METHODS Data were assembled from 2755 women aged 35 - 74 years who were diagnosed with incident invasive breast cancer while they were enrolled in a large health maintenance organization from 1977 through 1994 . Pharmacy data identified 174 users of HRT after diagnosis . Each HRT user was matched to four r and omly selected nonusers of HRT with similar age , disease stage , and year of diagnosis . Women in the analysis were recurrence free at HRT initiation or the equivalent time since diagnosis . Rates of recurrence and death through 1996 were calculated . Adjusted relative risks were estimated by use of the Cox regression model . All statistical tests were two-sided . RESULTS The rate of breast cancer recurrence was 17 per 1000 person-years in women who used HRT after diagnosis and 30 per 1000 person-years in nonusers ( adjusted relative risk for users compared with nonusers = 0.50 ; 95 % confidence interval [ CI ] = 0.30 to 0.85 ) . Breast cancer mortality rates were five per 1000 person-years in HRT users and 15 per 1000 person-years in nonusers ( adjusted relative risk = 0.34 ; 95 % CI = 0.13 to 0.91 ) . Total mortality rates were 16 per 1000 person-years in HRT users and 30 per 1000 person-years in nonusers ( adjusted relative risk = 0.48 ; 95 % CI = 0.29 to 0.78 ) . The relatively low rates of recurrence and death were observed in women who used any type of HRT ( oral only = 41 % of HRT users ; vaginal only = 43 % ; both oral and vaginal = 16 % ) . No trend toward lower relative risks was observed with increased dose . CONCLUSION We observed lower risks of recurrence and mortality in women who used HRT  after breast cancer diagnosis than in women who did not . Although residual confounding may exist , the results suggest that HRT after breast cancer has no adverse impact on recurrence and mortality OBJECTIVE To evaluate the feasibility of conducting a large r and omized trial of HRT in symptomatic women with early-stage breast cancer . DESIGN Open r and omized study . SETTING Outpatient clinics at The Royal Marsden and St. George 's Hospitals , London . PATIENT(S ) One hundred postmenopausal women with early-stage breast cancer , experiencing vasomotor symptoms and /or vaginal dryness . INTERVENTION(S ) R and omization ( 1:1 ) to HRT or no HRT for 6 months . MAIN OUTCOME MEASURE(S ) Acceptance , continuance rates , and the reasons eligible women declined study entry . RESULT ( S ) Acceptance ( 38.8 % ) and continuance rates ( > 80 % ) were encouraging . The efficacy of HRT did not appear to be antagonized with concomitant tamoxifen . Seventy-five percent of women continued HRT after the study ended . Three women developed metastatic disease . Two used  HRT .  CONCLUSION ( S ) Despite informed consent , a national UK r and omized trial of HRT should be feasible and has now been planned . Successful implementation necessitates the provision of information about HRT and the estrogen deficiency side effects of breast cancer therapy to health professionals and women with breast cancer In this paper , the association of hormones to vasomotor complaints during the menopausal transition is discussed . Fifty-seven regularly menstruating women without history of hormone replacement therapy ( HRT )  were selected for a longitudinal , prospect i ve study around the menopausal transition . The mean age at the start of the study was 51.3 ( + /-2.0 ) years . At intervals of 12 months all women went through a semi-structured interview and filled in question naires .  Venous blood sample s were collected every 12-month for analyses of estradiol ( E2 ) , testosterone , and rostendione , dehydroepi and rosterone-sulphate ( DHEA-S ) , follicle stimulating hormone ( FSH ) , thyrotropin ( TSH ) , and luteinizing hormone ( LH ) . Vasomotor complaints were tested using questions about hot flushes and bouts of sweating in terms of occurrence , frequency and degree of distress . Forty-six percent of the subjects reported hot flushes and bouts of sweating before menopause , increasing to 67 % during the first year after menopause and 49 % in the second year postmenopause . Low levels of estradiol and high levels of FSH were associated with vasomotor complaints before menopause . During menopause high levels of TSH were related to vasomotor complaints . The first year after menopause , women , who at this point achieved hot flushes , were characterised by high levels of E2 , but declining and low levels of FSH , but increasing . Postmenopausal , high levels of testosterone and DHEA-S seemed to protect against vasomotor symptoms . Our most important finding was , that among women who achieved hot flushes at the first assessment postmenopause , the high and rogen levels was a significant predictor of recovery from hot flushes at the last assessment , 1 year later The National Institutes of Health ( NIH ) has instructed participants in the estrogen-alone study of the Women ’s Health Initiative ( WHI ) , a large multi-center trial , to stop taking their study pills and to begin the follow-up phase of the study . Letters have been sent to all participants in the estrogenalone study , 11,000 healthy postmenopausal women who have had a hysterectomy , informing them of a recent NIH review of the study data . After careful consideration of the data , NIH has concluded that with an average of nearly 7 years of follow-up completed , estrogen alone does not appear to affect ( either increase or decrease ) heart disease , a key question of the study . At the same time , estrogen alone appears to increase the risk of stroke and decrease the risk of hip fracture . It has not increased the risk of breast cancer during the time period of the study . The increased risk of stroke 
    Output:
    
Therefore , the r and omized clinical trial data provide the only reliable estimates of the effect of HT use on recurrence risks in breast cancer survivors