As clinicians we try to be problem solvers. It is part of our training, try to figure out what’s wrong, and then to fix it. Problem solved. However, what should we do if what we are doing isn’t working? Keep doing the same thing? What if the patient does not get better? What if the patient doesn’t feel better? What if the incidence of CVD continues to increase despite all the medications we prescribe? What if the incidence of cancer continues to increase even though cancer treatments themselves once you get cancer have improved? It is often said that insanity is doing the same experiment over and over again expecting to see and hoping to see different results.
Why is there increased morbidity and mortality in those that don’t take ERT? This is simply because there is an increase in breast cancer recurrence in prior cancer survivors, around 350/10,000 women (that don’t take HRT). This does not mean, though, that taking estrogen increases the risk. However, those that do take BHRT do benefit from HRT despite the resistance from oncologists. The increase in breast cancer recurrence at baseline should not be extrapolated to what happens with treatment. In every study, treatment with estrogen decreases breast cancer risk. Observation at baseline does not prove causation. The most recent issue of JAMA proved that the only drug to decrease breast cancer mortality was estrogen! It was not a SERM or AI.
Since the 2002 report known as The Women’s Health Initiative (WHI) Trial, Prempro sales have fallen to $161 million annually and more than 10,000 lawsuits have been filed against Pfizer by women, who declared the company’s HRT drug lead to their development of breast cancer and other health ailments. Pfizer Inc. recently set aside $772 million to settle these cases.