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The Dangers of Hormone Therapy: Why Is It Still Prescribed?

Martha Rosenberg and Rowan Chlebowski, a lead investigator of the Women's Health Initiative, talk about why doctors still promote hormone therapy despite its health risks.

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M.R.: Critics of WHI say the large numbers of women who stopped taking estrogen and progestin or who took them when assigned placebo invalidate its status as a random controlled trial.

R.C.: The adherence rates were similar to those seen in other prevention large trials. When the intervention ended, after five and a half years, about 60 percent of women were still adhering to their study medication.

M.R.: You delivered an abstract at the annual San Antonio Breast Cancer Symposium in December about the bisphosphonate bone drugs some women now take in lieu of long-term HT to prevent osteoporosis. What about HT's other clear benefit--reduction of the risk of colon cancer?

R.C.: WHI data do demonstrate that HT lowers the risk of colon cancer. However those colon cancers that do develop tend to be more advanced and we are exploring why. This is why you haven't heard the colon cancer figures emphasized much.

M.R.: The New York Times reporter Tara Parker-Pope reported that there was internal discord at WHI over stopping the trials. Is that true?

R.C.: There was no disagreement with the estrogen plus progestin discontinuation but there was a difference of opinion about the decision to stop the estrogen alone trial because the risks appeared less. Of course these decisions are not made by the investigators but by data safety panels and external advisory committees.

M.R.: WHI has 40 centers and hundreds of researchers. How did you become first author on so many articles?

R.C.: I used to think you had to be the meanest of the bunch to be first author, but evidently not. (laughs) First authorship decisions are made from recommendations by a WHI Publication and Presentation Committee of those able--and willing--to do it. I believe the reason I have been asked to lead several cancer papers is that I am a medical oncologist and have published quite extensively about breast cancer and hormones. I'm grateful to the entire WHI team of investigators for their support.

M.R.: So as an oncologist and the "face" of WHI for several years, do you tell women to not take HT--except for very short-term use?

R.C.: Unless you have limiting climacteric symptoms (hot flashes, sexual difficulty), when you look at the emerging cancer data, is this really something you want to take?

Martha Rosenberg frequently writes about the impact of the pharmaceutical, food and gun industries on public health. Her work has appeared in the Boston Globe, San Francisco Chronicle, Chicago Tribune and other outlets.

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