Hormone replacement therapy, cancer, controversies, and women’s health: historical, epidemiological, biological, clinical, and advocacy perspectives
- Nancy Krieger1,
- Ilana Löwy2,
- Robert Aronowitz3,
- Judyann Bigby4,
- Kay Dickersin5,
- Elizabeth Garner6,
- Jean-Paul Gaudillière2,
- Carolina Hinestrosa7,
- Ruth Hubbard8,
- Paula A Johnson9,
- Stacey A Missmer10,
- Judy Norsigian11,
- Cynthia Pearson12,
- Charles E Rosenberg13,
- Lynn Rosenberg14,
- Barbara G Rosenkrantz13,
- Barbara Seaman15,
- Carlos Sonnenschein16,
- Ana M Soto16,
- Joe Thornton17,
- George Weisz18
- 1Department of Society, Human Development and Health, Harvard School of Public Health, Boston, USA
- 2Institute National de la Santé et de la Recherche Medicale, CERMES, Villejuif, France
- 3History and Sociology of Science Department, and Family Practice and Community Medicine, University of Pennsylvania, Philadelphia, USA
- 4Community Health Programs, Brigham and Women’s Hospital, and Director, Harvard Medical School’s Center of Excellence in Women’s Health, Boston, USA
- 5The Center for Clinical Trials and Evidence-Based Healthcare, Brown University, Providence, USA
- 6Gynecologic Oncology, Brigham and Women’s Hospital, and Dana Farber Cancer Center, Boston, USA
- 7National Breast Cancer Coalition, Washington, USA
- 8Department of Biology, Harvard University, Cambridge, USA
- 9Division of Women’s Health, Brigham and Women’s Hospital, and Connors Center for Women’s Health and Gender Biology, Boston, USA
- 10Harvard School of Public Health and Harvard Medical School, Boston, USA
- 11Our Bodies Ourselves, Boston, USA
- 12National Women’s Health Network, Washington, USA
- 13Department of the History of Science, Harvard University
- 14Slone Epidemiology Center, Boston University, Boston, USA
- 15Author
- 16Department of Anatomy and Cellular Biology, Tufts University School of Medicine, Boston, USA
- 17Center for Ecology and Evolutionary Biology, University of Oregon, Eugene, USA
- 18Social Studies of Medicine, McGill University, Montreal, Canada
- Correspondence to: Professor N Krieger Department of Society, Human Development and Health, Harvard School of Public Health, Kresge 717, 677 Huntington Avenue, Boston, MA 02130, USA; nkriegerhsph.harvard.edu
- Accepted 27 May 2005
Abstract
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.
- HRT, hormone replacement therapy
- WHI, women’s health initiative
- HERS, heart and estrogen/progestin replacement study
Footnotes
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Competing interests: none.
