HRT Bandwagon Went Down Wrong Road

If physicians are feeling betrayed by opinion leaders in their profession, their distress is understandable. For years, doctors heard from colleagues they trusted that hormone replacement therapy (HRT) was good for women. A combination of estrogen and progestin was supposed to protect women’s hearts, bones and brains from the ravages of aging.
When concerns about breast cancer were raised, doctors were frequently reassured. Some eminent gynecologists opined that if breast cancer was a risk, it was a minimal one, associated only with long-term HRT use. Such cancers were thought to be “good” cancers in that they were “early” cancers, easily detected and treated and not associated with increased mortality.
Confidant that what they were prescribing was helpful and not hurtful, physicians in turn reassured their female patients that HRT was both necessary and beneficial.
One angry reader of this column wrote: “After my breast cancer operation, the first thing I was told was that I could no longer take estrogen, because my tumor was ‘estrogen-nurtured.’ My primary physician’s position was–and continues to be–‘The benefits far outweigh the threat of breast cancer, and besides, WE CAN CURE BREAST CANCER.’ That’s what he said!”
Such physicians must now be feeling terribly guilty. The latest research (JAMA, June 25, 2003) proves beyond any doubt that combined hormone replacement therapy increases the risk of breast cancer. These new data suggest that such cancers occur after relatively short-term exposure and that when diagnosed, the tumors are more advanced. Worse, mammograms are less able to detect hormone-induced cancers.
Editorialists in the Journal of the American Medical Association conclude: “The ability of combined hormone therapy to decrease mammographic sensitivity creates an almost unique situation in which an agent increases the risks of developing a disease while simultaneously delaying its detection.”
Women and their physicians are justifiably outraged. They were misled by people they trusted. The result is a great deal of suffering.
Women who developed breast cancer, heart attacks or strokes while taking HRT must be wondering if the hormones were responsible. Some may feel violated. And physicians who prescribed HRT and then watched patients suffer from such serious ailments must be feeling remorseful.
Nobody can undo the damage that has been done. But we can learn from this debacle. In hindsight, we can see flaws in the research that supported HRT use.
Although thousands of studies were previously published, only the long-term (more than five years) Women’s Health Initiative proved the true benefits and risks of such therapy.
Since few prescribed medications are ever subjected to such a prolonged examination, physicians and patients must be wondering how other drugs might fare under such scrutiny.
Perhaps the moral of this sad tale is that health care providers should be more skeptical of pharmaceutical sales representatives and medical opinion leaders.
Such physicians are often rewarded for their pro-drug opinions with research grants and speaking engagements, which allow them to spread the word further. In the future, treatments should be based on sound data, not wishful thinking.