Time to move on from the risks of HRT? Where is the publicity on this?

My father was the son of an alcoholic bookmaker; raised in a very rough part of London and loading bricks before he went to school in the morning. His career as a Chartered Surveyor was forged through correspondence courses. He was a heavy smoker, and whenever I tried my best to ask him to stop smoking, he would say,

'In my opinion, current medical thinking is a very transient affair.'

Of course he was completely wrong about smoking and there can be no doubt at all about its harmful effects, but I did find myself repeatedly discussing with him reports which would contradict themselves over the years about a number of areas of medical advice. I am somewhat ashamed to find that this situation continues with controversy about matters COVID ie masks or no masks, hydroxychloroquine, vitamin D and the like.

So to my main topic. Where HRT is concerned there have been numerous studies which caused 'scares' and yet when revisited and analysed in a different way, yeilded a different answer. The WHI study published 2002 looking at acute cardiovascular events when women started HRT was one such study. Immense panic and a whole generation of women stopped life-changing treatment; unnecessarily. There is always huge publicity when there is a 'scare'....but why none when there is good news?

So can we at least as a society and medical fraternity lay to rest the argument about the risks of breast cancer from HRT? The JAMA paper published last month is a huge randomized placebo controlled trial of women receiving oestrogen alone (vs placebo) if previously hysterectomised, and oestrogen with synthetic progestogen (vs placebo) if not. The number of women recruited and the duration of follow-up of between 19 and 24 years makes evaluation of the endpoints of a diagnosis of breast cancer and death from breast cancer possible.

The conclusions here are straightforward. Oestrogen alone (and this was a rather old-fashioned type of oestrogen whereas now body identical oestrogen is the norm) has a protective effect on the development of breast cancer. Oestrogen plus synthetic progestogen causes a small but statistically significant increase in the incidence of breast cancer but no effect on the risk of dying of breast cancer.

It is possible, but not proven, that natural progesterone will not have this adverse effect on breast cancer incidence. It certainly looks as if synthetic progestogen should be kept to a minimum.

It is pleasing that the RCOG and BMS have issued a statement welcoming this paper, but again, why no media attention?

So please, as 'menopause' becomes part of the National curriculum in schools, can HRT be put in its rightful place as an option which women can consider if they wish to, without friends, family and even medical professionals overstating the risks. Eating healthily and exercising regularly, hence staying within a normal BMI range, remain the most important way of reducing breast cancer risk.