The use of estrogens and progestins

The use of estrogens and progestins
The use of estrogens and progestins

The use of estrogens and progestins


Order Instructions:

Write a 2- to 3-page word document to complete the following assignment tasks.
•Choose the research article you selected in W1 Assignment 3. Describe the sample, demographics, data collection process, setting, and the instrument, tool, or survey used in the article.
•Discuss the author’s summary about the validity and reliability of the instrument.

Cite all sources in APA format.



Description of the sample:

This prospective cohort study is an extension of a 1976 Nurses’ Health Study where patients 30-55 years of age were recruited and followup every 2 years from 1978 for 12 years.  From this cohort, a non-randomized sample of 50-69 years old postmenopausal women (all state registered nurses) were followed for additional two years through to 1992.  Participants were selected for followup based on the inclusion / exclusion criteria established from the 1976 questionnaires and baseline information on risk factors for breast cancer, including hormone therapy and subsequent menopausal status. Out of 725,550 women who were followed up, 1935 of them developed invasive breast cancer. Premenopausal women, as well as those who reported a  breast cancer incident or other cancer apart from nonmelanoma skin cancer at recruitment were excluded from subsequent followup.

The process of data collection:

Data was collected through the use of questionnaires and telephone interviews, commencing from 1976 when the study was initiated and through to 1992. The group of interest was postmenopausal women, who had been diagnosed with breast cancer and were currently undergoing hormone therapy. In order to determine any associations between the occurrence of breast cancer and hormones, data were stratified and further analysed by a multivariate analysis as a means of controlling the possible confounding effects that might be caused as a result of other risk factors.

The demographics of  the study population was as follows:

  • Origin/Sex/Education: All participants were US-based female state registered nurses.
  • Age: Study participants consisted mainly of postmenopausal women between the ages of 50 and 69 years, who were followed up every second year from 1976 to 1992.
  • Menopause status: This included the age of menopause onset and the type of menopause; whether women had a natural onset of menopause, had had hysterectomy but no bilateral oophorectomy or had had hysterectomy with bilateral oophorectomy, as well as the smoking status. In addition, women were furthered classified based on a breast cancer diagnosis, a history of cancer in the family, a family history of benign breast cancer and the time period.
  • Hormone use status: The hormone status included the duration of hormone use, the preparation of hormones used (use of progestin alone, conjugated estrogen alone, estrogen and progestin of estrogen and testosterone) and the dose. The cut off for the duration of hormone use related to high cancer risk was at 5 years.

Setting: The study was performed in the United States.

Instrument, tool, or survey used in the study.

  • Age standardized mammographic screenings were performed for breast cancer diagnosis.
  • Interviews at followup were done by telephone and by the use of structured questionnaires mailed to participants.
  • When participants did not return questionnaires, the National Death Index was used to ascertain the death of the nonrespondent cases.
  • Hospital records and pathology reports were used to confirm data on cancer diagnoses.

Validity and reliability of the instrument

Even though self-reporting and sampling questionnaires done by mail could be subjectively biased (Phellas, Bloch & Seale, 2012), the authors were confident in the accuracy of the participants’ reports; which according to them was extremely high, as they achieved nearly 100% followup completion through questionnaires and telephone for both nonfatal and fatal breast cancer respectively. Nevertheless, the administering of questionnaires as a sampling method is generally considered cheap, having no interviewer bias and with an added benefit of anonymity (Phellas, et al., 2012). While interviews have the advantage of being direct and have a better response rate (Phellas et al., 2012), its validity and reliability is still questionable, as it is not always possible to cross check information from self-reports. In this study, 10 cases of self-reported breast cancer could not be confirmed from medical records, further stressing the subjectivity of this method. Here, the authors validated the data for breast cancer occurrence using hospital records when available and the death of participants by use of the National death Index. In any case, this method is still unreliable in the event that the records are incomplete or in situations where medical records are unavailable, thus, resulting in “missing” data, as was the case in this study; wherein records could not be obtained for 7 percent of the self-reported cases of breast cancer.

Since age-standardised mammography could detect a larger proportion of in situ breast cancers, the validity / reliability of mammograms could be questionable as a tool for acquiring data relevant to the study. However, the authors accounted for this discrepancy by excluding such cases from the data analysis. Overall, data obtained with the above tools proved relevant to the objective of the study which set out to investigate the risk of developing breast cancer in postmenopausal women on hormone therapy; specifically estrogen and progestin. A review of literature was used  to corroborate facts, contradict findings or to indicate existing gaps in the literature on the subject. Meanwhile, the use of multivariate analyses further controlled for confounding factors.


Phellas, C.N., Bloch, A., & Seale, C. (2012). Structured methods: interviews, questionnaires  and observation. In C. Seal (Ed.), Researching Society and Culture. Retrieved from

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