In my opinion, in the absence of studies, in the absence of data, there is no right or wrong answer, |
Until data are available from randomized clinical trials, the patient's decision is the right decision -- support it. |
We all believe that oral contraceptives protect against ovarian cancer, ... Most of us believe that estrogen protects against coronary heart disease. We all believe that smoking causes lung cancer. |
We have a growing number of breast-cancer survivors who face a very difficult decision about whether or not to use HRT, |
We have over 50 studies, and there is no clear-cut answer, ... We have positive studies. We have negative studies. I think the state of the art was beautifully illustrated in 1995 when we had reports from (two) respected teams of epidemiologists with opposite conclusions, two weeks apart. |
Why do I believe it? Because every study says the same thing, |
With breast cancer and hormone replacement therapy, we have the opposite, ... We have lack of agreement, lack of uniformity, lack of consistency. That tells me that if hormone therapy has an effect on breast cancer, it has to be a small (one). If it were a major effect, a large effect, we would have agreement. |