[Effects of HRT on the risks of breast cancer and cardiovascular disease: the validity of the epidemiological evidence].
Publication of the findings of the Women's Health Initiative, in July 2002, the second link of the triptych made up of the Collaborative Reanalysis, in 1997, and the Women Million Study, in 2003, shortly after the WHI, seems to have tolled the knell of HRT, by claiming that women using HRT and combined therapy, have an increased risk of breast cancer and cardiovascular disease. As a result, the risk-benefit ratio would be reversed to the detriment of HRT. Over and above the legitimate questioning on the validity of these studies, such as calling into question their indisputable biases, especially the detection bias and hereby analysed in its spoiling the three randomised essays-there is the crucial question: can epidemiology make any headway in elucidating the hormonal aetiology of breast cancer? Indeed, given the low relative risks that have been observed, on the one hand, coupled with a whole set of methodological limitations, it is impossible to distinguish between bias and causation as alternative explanations for the observed associations. Above all, what emerges from this investigation is that, as far as HRT effects especially on breast cancer are concerned, epidemiological evidence only is inadequate, and collaborative research between histopathology and epidemiology is necessary.
Shapiro
S
S
Département d'épidémiologie, Mailman School of Public Health, université de Columbia, 2960 Broadway, New York, NY 10027-6902, Etats-Unis. sydzeev@aol.com
D015982:Bias; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology*; D015914:Estrogen Replacement Therapy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D012307:Risk Factors; D016387:Women's Health