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Hormone replacement therapy, cancer, controversies, and women’s health: historical, epidemiological, biological, clinical, and advocacy perspectives

¹ Department of Society, Human Development and Health, Harvard School of Public Health, Boston, USA
² Institute National de la Santé et de la Recherche Medicale, CERMES, Villejuif, France
³ History and Sociology of Science Department, and Family Practice and Community Medicine, University of Pennsylvania, Philadelphia, USA
⁴ Community Health Programs, Brigham and Women’s Hospital, and Director, Harvard Medical School’s Center of Excellence in Women’s Health, Boston, USA
⁵ The Center for Clinical Trials and Evidence-Based Healthcare, Brown University, Providence, USA
⁶ Gynecologic Oncology, Brigham and Women’s Hospital, and Dana Farber Cancer Center, Boston, USA
⁷ National Breast Cancer Coalition, Washington, USA
⁸ Department of Biology, Harvard University, Cambridge, USA
⁹ Division of Women’s Health, Brigham and Women’s Hospital, and Connors Center for Women’s Health and Gender Biology, Boston, USA
¹⁰ Harvard School of Public Health and Harvard Medical School, Boston, USA
¹¹ Our Bodies Ourselves, Boston, USA
¹² National Women’s Health Network, Washington, USA
¹³ Department of the History of Science, Harvard University
¹⁴ Slone Epidemiology Center, Boston University, Boston, USA
¹⁵ Author
¹⁶ Department of Anatomy and Cellular Biology, Tufts University School of Medicine, Boston, USA
¹⁷ Center for Ecology and Evolutionary Biology, University of Oregon, Eugene, USA
¹⁸ Social Studies of Medicine, McGill University, Montreal, Canada

Correspondence to:
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; nkrieger{at}hsph.harvard.edu

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.

Abbreviations: HRT, hormone replacement therapy; WHI, women’s health initiative; HERS, heart and estrogen/progestin replacement study

Keywords: hormone replacement therapy; oestrogen; cancer; women’s health; history

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