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Breast Cancer: 'Not a cookie-cutter business'

Years ago I asked Dr. Elizabeth Barrett-Connor, one of the leading experts on hormone replacement and a professor of epidemiology at the University of California, San Diego, for her help in reporting on the issues surrounding hormone replacement therapy.

"I think it's been a very trying time for the practitioner," she said. "I think we're at a very elementary stage of how to prescribe hormones."

I pointed out that some patients wonder how, 60 years into the game, the science of the hormone estrogen can still be at an elementary stage.

"Yes. It is interesting. But I ... do think we've made a lot of progress."

With a good deal of encouragement from drug companies, but little substantive evidence, millions of women came to see hormone replacement as a "cure" for the "disease" of aging. We now know that was fanciful.

There is no question that hormone replacement effectively treats hot flashes, mood swings and other symptoms of menopause. It also lessens the bone thinning of osteoporosis. But no one knows if it cuts the number of hip fractures, the biggest danger of osteoporosis. While doctors once thought hormone replacement reduced the risk of heart disease, the Women's Health Initiative (WHI), a placebo-controlled trial of 16,000 women--a sort of gold standard of medicine--found that it did not. Most importantly, in 2002 the WHI was halted because of the increased incidence of breast cancer in women taking the most common hormone replacement, estrogen and progestin, sold as PremPro. New results out today show that the cancer associated with that increased risk are more dangerous than many doctors had assumed.

The results show the importance of controlled clinical trials and the need to not rely on more casual observational studies before millions of people take a medication. There are countless questions about hormone replacement still to be answered

This is the new era of medicine where both patients and doctors know there is no right answer and today's answer might be different tomorrow. "I think both the doctor and the woman need to realize that every woman is different, Barrett-Connor said. "This isn't a cookie-cutter business."