The Controversy over Hormone Replacement Therapy: Evaluating Related Risk of Breast Cancer and Other Diseases

William P. Kucewicz

Judgment calls are inescapable in the practice of medicine. Physicians and patients must choose among different courses of treatment based on imperfect knowledge and incomplete information. Medical practitioners do their best with what's available. That's the way it is and presumably always will be. What then are we to make of the misinterpretation or misrepresentation of research data that leads to erroneous conclusions and misinforms doctors and their patients as to the best course of treatment?

An example of just such a case is explored in a highly revealing article, “Hormone Replacement Therapy: Real Concerns and False Alarms” by Avrum Z. Bluming, M.D. and Carol Tavris, Ph.D., published in  The Cancer Journal . In recent years, concerns have been raised about the possibility that hormone replacement therapy (HRT) significantly increases the risk of breast cancer, cardiac events, Alzheimer disease, and stroke. Apparently alarmed by the claims, the numbers of women receiving HRT declined by about half following the initial reports of a possible link beginning in 2002. (Hersh 2004) After reviewing the pertinent research data, however, Bluming and Tavris come to a startling and important conclusion – namely, that the reported findings that have been the source of so much concern were, in fact, “often distorted, oversimplified, or wrong.” And among those disseminating the alarmist information was the very institution conducting the HRT studies. (Bluming-Tavris 2009)

Dr. Bluming is a Master of the American College of Physicians, a Clinical Professor of Medicine at the University of Southern California, a former senior investigator for the National Cancer Institute and an oncologist in private practice. Dr. Tavris is a social psychologist, writer, and lecturer, fellow of the Association for Psychological Science, co-author of two leading psychology textbooks, and, most recently, of Mistakes Were Made (But Not by Me), with Elliot Aronson. The full text of their article, written at the suggestion of the American Council of Science and Health, whose panel of reviewers provided feedback to the authors, is available online for free from The Cancer Journal at:

http://journals.lww.com/journalppo/Fulltext/2009/04000/Hormone_Replacement_Therapy__Real_Concerns_and.1.aspx

and in PDF format at

http://pdfs.journals.lww.com/journalppo/2009/04000/1.pdf. (Bluming-Tavris 2009)

At the right margin, download William P. Kucewicz's layperson-friendly overview of the Bluming/Tavris paper.