The headlines were everywhere last winter: "Big Drop Seen in U.S. Breast Cancer Rates." This was, of course, wonderful and startling news. Cancer researchers from the MD Anderson Cancer Center in Houston, TX had just presented their data at a scientific conference in San Antonio, and the news was explosive. The New York Times wrote its lead editorial about this the following day, a clear sign that this was a story of major international importance. What had happened? Well, these researchers did an epidemiological study of cancer rates, finding that breast cancer rates fell by 7% in the year 2003 from the rates in 2002. This kind of drop doesn't just happen. Seven percent is a huge number when discussing a change in disease rates. It translated to 14,000 fewer women with breast cancer that year. Even better than those statistics was the news that the biggest effect was seen in women ages 50 to 69, and that the rates for the most common form of breast cancer-tumors that are estrogen receptor positive-fell by 15%.

How did this happen, and why? Why would breast cancer, the scourge of so many women and the reason for so many women's deaths over the past few decades, suddenly and precipitously decline? Perhaps you've read all the news stories as well and you know the punch line here; it was hormone replacement therapy. That's right, hormone replacement therapy.

In 2002, the results of the Women's Health Initiative were published, and they were shocking. This massive study, which aimed to discover the effects of hormone replacement therapy (HRT) on multiple aspects of women's health, had found that HRT did not prevent heart attacks, did not prevent osteoporosis, and did not prevent breast cancer. It actually seemed to increase those entities in some of the women studied. The impact of that publication was immediate. Thousands and thousands of women stopped taking HRT within days. This was in 2002. The drop in breast cancer rates occurred in 2003. A coincidence? Not likely. While epidemiology can never assert causality, the association of mass withdrawal of HRT and a huge drop in breast cancer the next year is unmistakable.

I'd like to be philosophical and scientific about this, but I can't do it. It makes me very angry. Why is it that women were almost routinely told to take hormones when they reached menopause anyway? Where was the evidence that said the hormones would help women? Where was the evidence that said the hormones would reduce the chance of disease in the future? Why were women told that the appropriate "treatment" for their body's natural function-menopause-was replacement of the hormones naturally lost during that time period? Could it be that in order to "treat" some uncomfortable but transitory symptoms, women (in huge numbers) took a pill that ultimately caused breast cancer, disfigurement, and death?

It's interesting to me now to hear "talking heads" on television discuss menopause as a natural phenomenon, the symptoms of which can be managed by eliminating high-necked sweaters and avoiding alcohol. Where were all these advisors when women were being told to replace the hormones their body had ceased making? I suppose I should be pleased that finally, finally, some reasonable advice is being given and women are no longer being told that a pill will fix menopause. Can we in the health professions learn from this massive error? Have we learned that there is not a pill for everything? That every medication we take has some consequence? Probably not, for I'm hearing a lot these days about women taking "natural hormones." This is particularly scary, for apparently women don't know that whether it's a "natural" hormone or a synthetic hormone, it's still hormone replacement.

I can't help thinking of all the women we've lost unnecessarily. Some of them were my friends. They never got to read the headlines.

Margaret Comerford Freda, EdD, RN, CHES, FAAN

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