Hormone replacement therapy and cancer risk – comment on NYT article

In last Saturday’s NY Times (11/7/26), there was an article entitled, “With Hormone Use, Doctors Warn Cancer Risk is Overlooked.” On balance, it was a very good article expressing concerns that, in terms of hormone therapy, the pendulum may well have overshot the mark.

When I was president of the Menopause Society more than a decade ago, for a decade there were approximately 2,000 members. Three years ago, it reached 6,000 members. This year, it has now surpassed 15,000 members. One year ago, the black boxed warning on estrogen was removed from the product label. This was a good thing. It had resulted in more than twenty years of doctors not being taught about hormones, being reluctant to prescribe hormones, and patients unwilling to take them.

However, it was the roll-out and publicity that was detrimental. Then FDA Commissioner Makary touted a 50% reduction in cardiovascular disease citing a single observational study from 1997, and a 30% reduction in Alzheimer’s citing a single Leisure World study in California in the 1990’s. Neither of these statistics is accurate or borne out with more modern data. Many newcomers to the field, however, blindly believed that a different formulation of natural hormones would automatically be safe and clearly the jury is still out.

My two biggest problems with this NY Times article are first, they, as so many others continue to do, are calling the women in the WHI who had had a hysterectomy as “the estrogen only arm of the WHI.” It was not. It was the conjugated estrogen only arm of the WHI. Estradiol was not used. It was a specific form of estrogen, that when studied through twenty years, actually reduced breast cancer incidence and breast cancer death.

Secondly, there was no mention of the drug Duavee. That combines the estrogen shown in the WHI to reduce breast cancer and breast cancer death with a selective estrogen receptor modulator (SERM) called bazedoxifene instead of pairing it with the usual progesterone. This agent has science, pre-clinical data, and a Phase 2 study on women with Stage 0 breast cancer pointing to the overwhelming likelihood that it, unlike traditional HRT, would actually reduce breast cancer incidence.