Sue Madsen

Replacement Estrogens and Endometrial Cancer

We examined the incidence of endometrial cancer in a large prepaid group practice in the Seattle area. From July, 1975, to July, 1977, there was a sharp downward trend in the incidence of endometrial cancer that paralleled a substantial reduction in prescriptions for replacement estrogens. Incidence rates were estimated for estrogen users and nonusers among women 50 to 64 years of age with intact uteri; current long-term users had an annual risk for endometrial cancer between 1 and 3 per cent, whereas nonusers had a risk less than 1/10th as great. These incidence rates remained fairly constant over time among users and nonusers; the drop in overall incidence soon after estrogen use declined suggests that the increased risk associated with estrogens falls quickly after discontinuation. The reduction in incidence of endometrial cancer in this group practice was part of a general decline in the United States after 1975.

Documenting outpatient problem intervention activities of pharmacists in an HMO.

The outpatient drug use review experiences by pharmacists at a large health maintenance organization with on-site pharmacies were investigated. Pharmacists were asked to document the nature of potential drug therapy problems encountered, drug involved, review activities undertaken, and processoutcomes. Patterns of pharmacist intervention were observed over 1 year. Results indicated that the number of problems detected increased substantially during the months immediately following the introduction of problem recording and feedback procedures. During the latter months, the number of prescriptions with problems approximated 4 per 100 dispensed prescriptions. Drug interactions of a moderate nature and drug underuse were the most frequent problem types encountered. Most were not serious and usually resulted in a cautionary or counseling message given to patients by pharmacists. The next most frequently occurring type was drug overuse problems, and, after that, problems concerning some aspect of the prescribing decision. In 9 per cent of all problem interventions and in 44 per cent of prescribing-problem interventions, the outcome of the pharmacist intervention was a change in drug, strength or directions for use. The average amount of pharmacist time per problem intervention varied from 6.0 to 7.8 minutes across problem types. This approximated a pharmacist labor cost of

SEDATING DRUGS AND AUTOMOBILE ACCIDENTS LEADING TO HOSPITALIZATION

0.06 per dispensed prescription, given a problem encounter rate of 4 per 100 dispensed prescriptions.

Vaginal spermicides and miscarriage seen primarily in the emergency room

The use of central nervous system depressant drugs among 244 people hospitalized for injuries suffered in an automobile accident was similar for drivers presumed at fault for the accident compared with other drivers and passengers. It was only slightly higher in the three groups than it was in the population at large. The absence of an important association in this population might be related to the warnings given to people filling prescriptions for these drugs.

Oral Contraceptives and Breast Cancer

Among 813 women who had obtained a vaginal spermicide within 48 weeks of the estimated date of fertilization (EDF), 47 (5.8%) had an early miscarriage. Among women who had obtained oral contraceptives, 35/1,127 (3.1%) miscarried, and among women who obtained neither, 140/4,231 (3.3%) miscarried. The risk ratio estimate comparing spermicide users with nonusers was 1.8 (90% confidence interval 1.4, 2.3). The association was strongest among women who had obtained a spermicide within 12 weeks of the EDF. Examination of abortus material revealed that the association with spermicides was strongest among those where an abnormal fetus was present.

REPLACEMENT ESTROGENS AND BREAST CANCER

The incidence of breast cancer among users and non-users of oral contraceptives (OCs) was determined at Group Health Cooperative of Puget Sound, Seattle, Washington, a health care organization which maintains computer files of diagnoses and outpatient drug use. In women 45 years of age or younger, the incidence was nearly identical in users and non-users. In premenopausal women over 45 years of age, there was a positive association between current OC use and breast cancer, the risk ratio estimates and 90% confidence intervals being 4.0 (1.8-9.0) in women 46-50 years of age and 15.5 (5.2-46) in women 51-55 years of age.