Hormone replacement therapy, cancer, controversies, and women's health: historical, epidemiological, biological, clinical, and advocacy perspectives.
Routine acceptance of use of hormone replacement therapy (HRT) was shattered in 2002 when results of the largest HRT randomised clinical trial, the women's health initiative, indicated that long term use of oestrogen plus progestin HRT not only was associated with increased risk of cancer but, contrary to expectations, did not decrease, and may have increased, risk of cardiovascular disease. In June 2004 a group of historians, epidemiologists, biologists, clinicians, and women's health advocates met to discuss the scientific and social context of and response to these findings. It was found that understanding the evolving and contending knowledge on hormones and health requires: (1) considering its societal context, including the impact of the pharmaceutical industry, the biomedical emphasis on individualised risk and preventive medicine, and the gendering of hormones; and (2) asking why, for four decades, since the mid-1960s, were millions of women prescribed powerful pharmacological agents already demonstrated, three decades earlier, to be carcinogenic? Answering this question requires engaging with core issues of accountability, complexity, fear of mortality, and the conduct of socially responsible science.
Krieger
Nancy
N
Department of Society, Human Development and Health, Harvard School of Public Health, Kresge 717, 677 Huntington Avenue, Boston, MA 02130, USA. nkrieger@hsph.harvard.edu
Löwy
Ilana
I
Aronowitz
Robert
R
Bigby
Judyann
J
Dickersin
Kay
K
Garner
Elizabeth
E
Gaudillière
Jean-Paul
JP
Hinestrosa
Carolina
C
Hubbard
Ruth
R
Johnson
Paula A
PA
Missmer
Stacey A
SA
Norsigian
Judy
J
Pearson
Cynthia
C
Rosenberg
Charles E
CE
Rosenberg
Lynn
L
Rosenkrantz
Barbara G
BG
Seaman
Barbara
B
Sonnenschein
Carlos
C
Soto
Ana M
AM
Thornton
Joe
J
Weisz
George
G
D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control; D004345:Drug Industry; D005260:Female; D020249:Hormone Replacement Therapy / Q000009:adverse effects*; D006728:Hormones / Q000502:physiology / Q000627:therapeutic use; D006801:Humans; D007221:Industry; D009369:Neoplasms / Q000453:epidemiology / Q000209:etiology*; D010344:Patient Advocacy; D010817:Physician-Patient Relations; D012306:Risk; D019529:Sexuality; D012926:Social Control, Formal / Q000379:methods; D012941:Social Responsibility; D016387:Women's Health
D006728:Hormones