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Breast cancer is the most prevalent form of cancer and the second leading cause of mortality, affecting 1 in 9 women in the United States. Recent studies have shown that antipsychotic drug use is associated with increased prolactin levels, which, in turn, is associated with increased risk of breast cancer. However, studies of the association between antipsychotic drug use and the risk of breast cancer are sparse and have largely been conducted in homogenous populations. Therefore, we evaluated this relationship in postmenopausal women (N = 119 524) in a diverse population of the Women’s Health Initiative (WHI) cohort. Antipsychotic drug use was self-reported and in situ and invasive breast cancer cases were confirmed by medical records for the WHI clinical trial (CT) and the WHI observational study (OS), from 1993 through 2018. We used Cox proportional hazards regression to model breast cancer risk against antipsychotic drug use while adjusting for dietary and lifestyle factors. Overall, antipsychotic users made up 0.41% of this population. There was no overall association between antipsychotic drug use and postmenopausal breast cancer risk (HR = 1.01, 95% CI = 0.73 – 1.40). Among typical antipsychotic drug users, there was a suggested two-fold increased risk in developing in situ breast cancer (HR = 2.02, 95% CI = 0.84, 4.86). Thus, antipsychotic drug use does not appear to increase breast cancer risk overall, but the potential association between antipsychotics and in situ breast cancer merits further study.

Hypertension is a chronic disease with an estimated prevalence of nearly 50% in US adults. In addition to sociodemographic and lifestyle factors, evidence suggests that in utero and early life exposures may contribute to life-long risk of hypertension. This study aimed to investigate the potential associations between an individual’s birthweight and preterm birth status with their risk for hypertension in the Women’s Health Initiative (WHI) cohort. WHI is a large, multi-racial cohort of postmenopausal women. At study entry, birthweight and preterm birth status were self-reported by category (< 6 lbs., 6-7 lbs. 15 oz., 8-9 lbs. 15 oz., or ≥ 10 lbs.; ≥ 4 weeks premature or full term). Baseline and incident hypertension status were self-reported; mean systolic blood pressure, diastolic blood pressure, and 30-second pulse were also recorded at baseline by trained study staff. Linear, logistic, and Cox-proportional hazards regression models were used to generate crude and adjusted beta estimates, odds ratios, and hazards ratios, respectively. After adjusting for demographic and lifestyle factors, we found that participants born at a low birthweight had a higher mean systolic blood pressure than participants born at a normal birthweight and were at increased risk for both baseline and incident hypertension. Women born at a higher birthweight had a lower mean systolic blood pressure and were at lower risk for baseline and incident hypertension. When compared to participants born full term, participants born preterm were at increased risk for baseline and incident hypertension. These results support current research on early life exposures and health risks later in life. Long term follow-up or targeted counseling may be required for individuals born prematurely or at low birthweights to prevent and treat hypertension and associated cardiovascular outcomes.

Colorectal cancer is the third most common cancer among U.S. women; 63,610 new cases were estimated to have occurred in 2015. Prior studies found a reduced risk of colorectal cancer among antidepressant (AD) users, however, none adjusted for depression, which is itself linked to increased colorectal cancer risk and could confound this relationship. We assessed the relationship between ADs and AD drug classes with risk of colorectal cancer in a prospective cohort of 145,190 women between the ages of 50-79 without a previous history of cancer at enrollment. Current AD use was assessed at baseline. Over an average follow-up of 14 years, there were 5,280 incident cases of colorectal cancer cases. Cox proportional hazard ratios, adjusted for potential confounders including depressive symptoms, were used to estimate hazard ratios. Of all AD users, 51.1% used selective serotonin reuptake inhibitors (SSRIs), 40.7% used tricyclic antidepressants (TCAs), and 15.1% used other ADs. No association was observed between total AD use, SSRI use, and/or other ADs and risk of colorectal cancer. We observed a reduced risk of colorectal cancer among TCA users, which was significant for colon cancer specifically (HR 0.68, 95% CI: 0.48-0.96). Although a reduced risk of colon cancer was observed for TCAs use for less than two years (HR 0.39, 95%: CI 0.19-0.82), no association was observed for TCA use for two or more years (HR 0.85, 95%CI: 0.57-1.26). Our data suggests a protective association between TCA use and risk of colorectal cancer, however more research is needed to verify these findings.

As a result of the recent findings of the Women's Health Initiative (WHI), many women who have been on hormone replacement therapies (HRT) have begun to renegotiate their understandings and strategies of this stage of their lives. The WHI findings suggested that the risks of HRT outweighed the benefits for healthy menopausal women. This study examined women's emerging sensemaking regarding HRT and menopause in light of the WHI findings. Seven women in the Tampa Bay area, who were in various stages of menopause, participated in three focus group sessions and two one-on-one interviews to discuss their lives in menopause. Based upon the women's conversations, I constructed individual stories about each of the women. I included my voice in each step of the process, both participating in the focus group and interview discussions and inserting my voice in the women's stories as an interview and focus group participant. I analyzed the stories to determine categories in the w omen's emerging sensemaking. A theme of change emerged in terms of loss, decay, and decline. The women talked about change while discussing personal issues such as children, their bodies, aging, health concerns, and sex. Throughout their discussions, the women spoke about the contradictions and dilemmas they faced as they tried to sort through the conflicting and sometimes contradictory information they have been receiving about the effects of menopause and HRT on their bodies. Emily Martin's medical metaphors, Michel Foucault's ideas on discourse, and Watzlawick, Weakland, and Fisch's theory of change helped me understand the women's sensemaking. Many of the women framed their sensemaking within the biomedical model of health care, using what Martin called the body-as-machine metaphor, thereby making a first-order change, even though they changed from one HRT formula to another, from "synthetic" to "natural" HRT, or stopped taking HRT entirely. One woman appeared to make a secon d-order change. Overall, the women felt they had little to guide them as they determined how to take care of themselves in the menopausal stage of their lives.

Background: Recent studies are changing the way physicians and patients view hormone replacement therapy (HRT). This study was performed at the East Tennessee State University (ETSU) internal medicine clinic to evaluate the current behaviors of university physicians and patients with respect to HRT. Methods: A retrospective chart review was conducted at the main internal medicine outpatient clinic at ETSU. Two hundred seventy-four postmenopausal female patients were randomly selected using a computerized systematic sampling technique of International Classification of Diseases, Ninth Revision (ICD-9) codes for menopause or postmenopause. The study period was from July 2002 until June 2004. Patients were postmenopausal women age 35 years or over who had been seen by their physicians at least twice a year during the study period. Patients who were noncompliant with HRT or physician's visits or had contraindications or side effects to HRT mandating discontinuation of the treatment were excluded. Data regarding physicians' patterns in discussion and discontinuation of the therapy and patients' responses were collected. Epi Info 2002 was used for statistical analysis. Results: One hundred seventy-seven patients met all of the criteria, of whom 140 were 35 to 75 years of age. Of this age group, 49 patients (35%) had coronary artery disease (CAD), 101 (72.1%) were on HRT prior to July 2002, and 30 (21.4%) had osteoporosis. Seventy-five patients (53.6%) had documented discussions with their physicians about HRT after July 2002. Most patients who were on HRT had no CAD (p = .0008). Of the patients who were on HRT, only 36 (35.6%) continued treatments (23 continued the same dose, and 13 had the dose modified), whereas 65 (64.3%) had treatments discontinued. HRT discussions were carried on mostly when patients had treatments stopped or modified (p = .0032). Of these patients who had discussions, 60 (80%) were advised to stop or modify the dose and agreed, and only 15 (20%) disagreed or received unbiased discussions from their physicians about HRT. Thiry-seven patients were over 75 years of age. This older group had a higher rate of HRT discontinuation (82%) but a lower rate of documented discussion (22%) than the younger group. Conclusion: Physicians should pay more attention to the importance of providing high-quality and well-balanced patient counseling when addressing uncertain treatments and adequately document discussions with patients in medical records.