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World renowned scientist takes a critical, new look at breast cancer data
JACKSON, Miss. -- There is no breast cancer epidemic in America.
There is no association between hormone replacement therapy and increased diagnosis of breast cancer.
Women who take hormone replacement, however, are 20 to 40 percent less likely to die earlier, from all causes.
Thus, the medical advantages of hormone replacement therapy far outweigh the disadvantages.
That is probably not what you've heard.
"But that's the bottom line," said Dr. Trudy Bush, who believes scientists and the media shouldn't be swayed by what everyone expects or even wants to hear.
"My philosophy of science is this: truth exists and we try to discover the truth," Bush said. "Every time we do a study, we take a sample of the truth."
Bush, an internationally renowned authority on breast cancer and hormones, spoke in an interview and a lecture this week on Estrogen and Breast Cancer: A Differing View at the University of Mississippi Medical Center (UMC). More than 250 health care professionals and members of the public came to hear the epidemiologist.
Bush is a professor of medicine specializing in epidemiology, preventive medicine and cardiology at the University of Maryland, Baltimore. She also is an adjunct professor at Johns Hopkins University. The Pennsylvania native has received numerous grants and contracts for research projects on female hormones. She has published more than 130 papers and serves on numerous boards relating to women's health and menopause. This year, she was honored by Mayo Clinic as the Elizabeth Blackwell Lecturer in Internal Medicine.
"She gave an absolutely scintillating and in-depth look at a problem that worries women and plagues doctors who care for women," said Dr. John C. Morrison, chairman of UMC's Department of Obstetrics/ Gynecology. "Her insight that breast cancer being caused by hormones was a perceived threat rather than truly related to cancer should be reassuring to everyone."
The outspoken scientist not only came armed with her credentials for her speech, but also Bush surveyed numerous studies that juxtapose hormone replacement therapy (HRT) with diagnosed breast cancer.
Although studies linking breast cancer to HRT gain the most media attention, they're scientifically offset by as many studies that indicate there's no correlation or that HRT even decreases women's breast cancer risk. The latter studies don't attract nearly as much media attention, Bush showed. Such contradictory study results are what scientists expect to see when there's no actual association between the cause and effect investigated, in this case HRT and breast cancer.
"It's utterly sloppy science," she said of some researchers' conclusions about data. Her talk often served as a primer on how to properly collect and interpret data.
The "prevailing wisdom" about breast cancer vs. hormones shifted in the last decade, as breast cancer awareness campaigns influenced media coverage and scientific analysis alike, she explained. Breast cancer remains a leading cancer killer of women, but there's no epidemic, she said -- adding that the real cancer epidemic among women is lung cancer.
"My goal is to help women identify their realistic threats," she said.
She also noted that there's no increased diagnosis of breast cancer among women with a family history of the disease who are on HRT.
Bush said women may take HRT up to 20 years, which is the time span of the longest studies, for a preponderance of health benefits.
Major benefits of HRT for women may include cardiovascular protection, relief from hot flashes, protection against osteoporosis, decreased incidence of colon cancer, and decreased incidence of mental dementia.
There are, however, potential health problems associated with HRT, she added -- including, for patients at risk, effects on the gall bladder that could increase the likelihood of needing gall bladder surgery and enhancing blood clotting that could lead to deep venus thrombosis (DVT) or pulmonary embolism, again for at-risk patients.
"But when you add everything up, the benefits far, far outweigh the risks," Morrison agreed. "That's the way I counsel patients and that's why I have every menopausal woman in my family on hormone therapy -- my wife, my mother-in-law, my sister."
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