Annual Report 2014
By Diane Mapes
The Women's Health Initiative, launched in 1993, is one of the largest and most ambitious prevention studies ever conducted in the U.S.
Designed to address research inequities and provide strategies to thwart heart disease, breast and colorectal cancer, and other leading causes of death and disability in older women, the WHI has gathered health information from 161,000-plus post-menopausal women for nearly a quarter of a century. That wealth of data has been systematically managed and analyzed at Fred Hutch, the WHI's Clinical Coordinating Center, so researchers can glean from it crucial, lifesaving insights.
Powered by an initial $625 million grant from the National Institutes of Health, the WHI has tackled everything from the health effects of hormone therapy and diet to life and longevity after cancer.
Given its expense, the WHI's perceived worth has also been bandied about for decades. But a newly published Fred Hutch study has gone far to lay that discussion to rest.
Dr. Joshua Roth, a postdoctoral fellow in the Hutchinson Institute for Cancer Outcomes Research (HICOR), analyzed the return on investment of just a portion of the WHI's work, the landmark finding that combined hormone therapy, or CHT, significantly raised a woman's chance of developing cardiovascular disease, stroke and breast cancer.
"The economic return from the trial is substantial," Roth said when announcing his results in May. "The original NIH trial cost was $260 million (in 2012 dollars) and the net economic return was $37.1 billion. That's a return of approximately $140 on every dollar invested in the trial."
Roth, who used a mathematical model to estimate the influence of a "no WHI world," showed the CHT finding also directly led to 126,000 fewer breast cancer cases, 76,000 fewer cases of heart disease and stroke and 80,000 fewer cases of venous thromboembolism between 2003 and 2012.
"It really brings the point home when you crunch the numbers," he said. "You see that millions of U.S. women likely stopped or never used CHT and that this change resulted in important reductions in disease incidence and associated medical spending."
Former Fred Hutch board member Jean Rolfe is one of the thousands of women who not only participated in WHI's work but, along with her three daughters, stood to benefit from it. The longtime civic leader said Roth's study brings a new and necessary perspective to the WHI's findings.
"This really substantiates what the research accomplished," she said.
Although Rolfe was not part of the CHT investigation, for five years she provided WHI researchers with vital health data for another study arm.
Her involvement was just part of a pattern of public health service that started when she was a young girl.
"My mother was a very big volunteer at (Seattle) Children's, and I would go with her during the summer and that whetted my appetite," she said. "My husband said I'd been practicing without a license for a very long time."
Rolfe's long-standing relationship with Fred Hutch began in the 1980s and has included stints as board and senior council member, public speaker, donor and Board of Ambassadors co-chair.
"They would report findings to us as board members and I always felt a great sense of accomplishment that I had something to do with it," she said of her WHI participation. "It really appealed to me because it was women my children's age and my age and above."
Rolfe, who currently champions Fred Hutch by emceeing events that introduce Hutch science to the community, said her involvement gave her a unique perspective on cancer prevention research.
"Not everybody understands public health so doing something within the (Public Health Sciences) division better enabled me to speak to (that)," she said.
Dr. Garnet Anderson, principal investigator for WHI's Clinical Coordinating Center and director of the Hutch's Public Health Sciences Division, emphasized the incredible value of the contributions made by Rolfe and other participants.
"That data has been used extensively," Anderson told Rolfe. "We have probably published over 1,000 papers using data that you've contributed to."
Anderson also hailed Roth's study for highlighting WHI's impact both in terms of saving money and human lives.
"This is what prevention studies can do and we're trying to get that word out," she said. "These findings underscore the significant role clinical trials play in science and the importance of continuing to find ways to strategically invest public research funds to maximize value to society. It's brought a new perspective to think about it as an investment."
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