An article published July 17, 2002 in JAMA by authors from the National Cancer Institute concludes that women, who use estrogen replacement therapy, particularly for 10 or more years, were at a significantly increased risk of ovarian cancer. The relative risk in that study was increased, but the absolute risk was incredibly small. The relative risk for taking estrogen alone was increased by 1.6, but the absolute risk was increased from 4.4 cases per 10,000 women-years to 6.5 cases per 10,000 women-years. This is an absolute increase of 2.1 cases per 10,000 women-years, equivalent to the one year risk of driving of 1:5000. After 10 years the relative risk was reported as 1.8, “a significant increased,” but the absolute risk was increased from 4.4 to 6.9 cases per 10,000 women, an increase of 2.5 cases per 10,000 women, less risk than driving for two years.

In addition, in the non-HRT users and the HRT/ERT users there were more cases of ovarian cancer than would be expected, based on the most recent NCI statistics, strongly suggesting surveyor and/or respondent bias.

But why take HRT at all, since in the same edition the Women’s Health Initiative announced it was discontinuing the Estrogen-Progestin arm of the WHI. The reason is that the NIH has casually thrown out 5 long-term observational studies showing a dramatic decrease in Alzheimer’s because of one study showing no benefit. They have also disregarded 11 long-term studies and all animal models showing dramatic protection from heart attack and death from heart attack because of the negative findings from two poorly designed studies showing no cardiac benefit. They are apparently blind or have not seen the incredible difference in the appearance, health, and vitality of women on hormones compared to women of the same age not on hormones. Clinicians providing healthcare see this every day, week, and month. There is never any question of who is healthier when two women of the same age in their 70s or 80s are seen – one who has been on HRT or ERT and the other on none. Deprivation of HRT has the same effect on women as castration on men. At what age is castration recommended for men to improve their general health? Castration is only recommended for men with metastatic prostate cancer and a recent article questioned that because men were so miserable from the loss of testosterone. This is equivalent to recommending HRT for women with metastatic breast cancer because of hot flashes!

Conclusion
The absolute risk increase, if not due to observer bias, was very small. Most positive findings have been casually disregarded by the NIH. The benefits for Alzheimer’s, osteoporosis, prevention of endometrial cancer, prevention of heart disease and stroke, sexual function, and general vitality far outweigh the slight increase in absolute risk.

Estrogen and hormone replacement therapy should be discontinued at the same age as is recommended for men to be castrated for their general health.