Joan Bakewell: Why I intend to keep taking HRT

Medical research should carry a health warning: this report may damage your peace of mind
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The Independent Online

Thanks ... but no thanks. Medical research is a wonderful thing, and there's sensational news almost daily of how science is on the way to solving diabetes and genetic defects. But there is a downside: the risk factor.

We can certainly expect new concoctions of chemical treatments to have unknown repercussions. The same applies to research findings and claims for new evidence. Medical research should carry its own health warning: this report may seriously damage your peace of mind. Most particularly, this applies to anything ever said about hormone replacement therapy (HRT).

This week has seen headline-grabbing news about HRT and ovarian cancer. If women are expected to attend this news in a mood of calm reasonableness, consider the vocabulary that confronts them: "HRT alert", "linked to ... deaths". "Died ... after taking ...". Consider the serious-minded places that reported the story: the front page of The Times, the BBC news headlines - both authoritative media.

The story was posted on The Lancet website. The Lancet? Then it must be true. Cancer Research UK, which funded the report, has given it full publicity backing. That's, after all, what they're meant to do. We want to know. We want to be well informed. We want to make reasonable judgements.

But what, exactly, are we being told? We are certainly told to be alarmed. I almost suspect male editors and headline writers of taking pleasure in putting the frighteners on women. "Hormone replacement therapy was welcomed with a feminist wave of enthusiasm in the 1960s. It was safe, natural and rejuvenating, its supporters argued - and women deserved no less," declared a (male) health editor. Serves those uppity bitches right, seems the implication. Another case of the Sixties being to blame.

But after all the alarm, the story gets confused. Back in 1996, and for a period of five years, the UK-sponsored Million Women Study recruited 1.3 million women around the age of 50. They completed questionnaires about their lifestyles, their social and demographic background and their use of hormone replacement therapy, a treatment used as a way of ameliorating the distressing symptoms of the menopause.

Three years later, they filled in another questionnaire, and participants have, I understand, been regularly followed up. Today's study, from Cancer Research UK's epidemiology unit at Oxford University, tells us that those who take HRT for more than five years risk death from ovarian cancer. From their seven-year study the unit has extrapolated that HRT might have been responsible for 1,300 cases of ovarian cancer over 14 years, a much longer period than the study covered. The same researchers have shown that women who take the treatment are at an increased risk of breast and womb cancer.

But these findings are challenged by the British Menopause Society, which suggests the Oxford unit may be extrapolating its findings over a longer period - 14 years - "as a means of sensationalising their results". What's more, the BMS claims that, although there has been a clear fall in the use of HRT, especially in Britain, after the Million Women Study's earlier findings, "breast cancer rates have not declined as a consequence".

The BMS goes on: "The study still has the same major flaws that were exposed when their breast cancer data was published ... compared to the largest randomised trial of HRT, their breast cancer findings were a gross overestimation of the incidence. It may well be that their ovarian cancer data is also an overestimation."

So where does all that leave women? And where do I stand in all this? The answer is right in the middle. I have a great many close friends who have had breast cancer. They have endured a variety of treatments, from major surgery, minor surgery, radiotherapy and chemotherapy. They have shown endurance through the darkest days of radiation, and shown resilient good humour at the indignities of hair loss. As a patron of Breast Cancer Care, I know how good women are at supporting each other from the moment of the traumatic diagnosis right through to post-operative care.

But it isn't all Pollyanna optimism. My own sister, six years my junior, had major breast surgery, survived for almost five years, and then the cancer returned and killed her. Even so, I've been taking HRT for some 20 years. I believe it helps avoid osteoporosis, and may well help avoid strokes and heart problems. I also have a feeling - and it may be no more than a superstition - that it is helping keep my energy and stamina going.

But please don't copy me. This business of medical treatments is highly personal. Even more so is how we each assess the risks we are prepared to take, how we balance the pros and cons of available evidence and what credence we give the motley array of statistics that pour from any authoritative research.

What I intend to do, in the face of this latest alarm, is wait and read. Slowly scientists and medical boffins will begin the business of assessing and evaluating this piece of research. They will report on just how robust the study is. Only then will I decide what risks are worth taking. Meanwhile, from another part of the forest - the European Journal of Cancer Prevention - comes news that tea may actually reduce risks of skin and ovarian cancer. So perhaps I'll just make myself a nice cup of Earl Grey.

joan.bakewell@virgin.net

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