Cumulative use of combined hormone replacement therapy (estrogen + progestin / progestoge...

Детермінований перегляд YAML-сутності з джерельної бази. Клінічний авторитет лишається за вказаними source ID та статусом клінічного sign-off.

ID	`RF-IATROGENIC-COMBINED-HRT-PREVENTION`
Тип	Тривожна ознака
Статус	переглянуто 2026-05-18 \| очікує клінічного підпису
Хвороби	`DIS-BREAST` `DIS-ENDOMETRIAL`
Джерела	`SRC-NCCN-BREAST-2025` `SRC-NCCN-UTERINE-2025` `SRC-USPSTF-BREAST-2024`

Походження тривожної ознаки

Визначення	Cumulative use of combined hormone replacement therapy (estrogen + progestin / progestogen) ≥5 years in postmenopausal women — IARC Group 1 carcinogen (combined menopausal therapy). Elevated risk profile: breast cancer +1.2-1.7x with current use, magnitude scaling with duration (~+8 cases per 10,000 woman-years per WHI Combined-HRT arm at year 5), effect attenuates within 5-10 years of stopping; endometrial cancer risk depends on regimen: continuous combined HRT (daily estrogen + daily progestin) NEUTRAL or slightly protective vs no HRT (~RR 1.0-1.1) — the progestin opposes estrogen-driven endometrial proliferation. Sequential / cyclic combined regimens (estrogen daily + progestin 10-14 days/month) carry a smaller but measurable endometrial-cancer signal (~RR 1.2-1.5) vs continuous combined. Estrogen-ALONE HRT in a woman with intact uterus carries marked endometrial cancer risk (~RR 5-1...
Клінічний напрям	investigate
Категорія	other

Логіка спрацьовування

{
  "any_of": [
    {
      "finding": "combined_hrt_continuous_use_ge_5y",
      "value": true
    },
    {
      "finding": "combined_hrt_sequential_use_ge_5y",
      "value": true
    },
    {
      "finding": "prior_combined_hrt_ge_5y_within_decade",
      "value": true
    }
  ],
  "type": "lab_value"
}

Нотатки

Prevention-persona RedFlag for combined HRT exposure ≥5y. Engine routes to PreventionPlan recommending (1) shared-decision discussion of risk-benefit (vasomotor symptoms, bone-density preservation vs breast / VTE / cardiovascular risks), (2) lowest-effective-dose + shortest-duration principle per NAMS / ACOG, (3) breast surveillance per USPSTF cadence — supplemental imaging not recommended on HRT alone (density-related supplemental imaging is a separate axis), (4) symptom-prompted endometrial workup (any abnormal bleeding → TVUS + biopsy) for women on sequential/cyclic combined or with intact uterus on any HRT, (5) annual GYN exam. Distinct from RF-IATROGENIC-TAMOXIFEN-ENDOMETRIAL-PREVENTION (different mechanism: SERM with partial endometrial agonism). STUB pending two-Clinical-Co-Lead signoff per CHARTER §6.1 dev-mode.

Де використовується

Indications

IND-IATROGENIC-COMBINED-HRT-PREVENTION-OBSERVATION - IND-IATROGENIC-COMBINED-HRT-PREVENTION-OBSERVATION
IND-IATROGENIC-COMBINED-HRT-PREVENTION-SURVEILLANCE - IND-IATROGENIC-COMBINED-HRT-PREVENTION-SURVEILLANCE