If you’ve ever hesitated to start hormone therapy because of something you heard about breast cancer risk—you’re not alone. For over 20 years, the Women’s Health Initiative (WHI) has cast a long shadow over hormone therapy, thanks to its 2002 press conference and subsequent media frenzy that linked estrogen-progestin therapy to increased breast cancer risk.
But what if that terrifying headline was built on flawed interpretations and statistically insignificant results?
Cue: ‘Tis But a Scratch—a critical and beautifully blistering review of the WHI’s claims, penned by Drs. Bluming, Hodis, and Langer, who meticulously dismantle the breast cancer panic the WHI helped fuel.
What the WHI Got Wrong (And Why It Matters)
The WHI claimed that CEE + MPA (a type of combined hormone therapy) increased breast cancer risk. But this review shows that:
- The reported risks were not statistically significant when properly adjusted for key variables like prior hormone use and baseline risk factors.
- The group with the “scary” increase in risk? It actually had an unusually low baseline rate of breast cancer, making the therapy group’s numbers look inflated.
- The most robust analysis shows no significant increase in breast cancer risk with CEE + MPA—and no increase in breast cancer deaths.
- In fact, CEE alone (estrogen without progestin) decreases breast cancer risk by 23% and breast cancer mortality by 40%.
Let that sink in.
Misleading the Masses
The authors also take aim at studies like the Million Women Study and the Collaborative Reanalysis, both of which have serious methodological flaws but continue to be cited as gospel. (Two questionnaires and a 44% response rate do not a reliable study make.)
And while some WHI investigators continue to defend their early conclusions, even their own data contradicts them—and newer analyses from within the WHI itself walk back most of those original fears.
The Real Cost of Fear
This isn’t just academic nitpicking. The fallout from the WHI’s initial misinterpretation has been devastating:
- Millions of women were deprived of safe, effective symptom relief
- Hormone therapy use plummeted
- Mortality from other causes—like heart disease and hip fractures—went up, especially in women who had hysterectomies and were denied estrogen
- Misinformation still shapes how doctors are trained and how patients are counseled
The Bottom Line
When prescribed appropriately—especially to women in their 40s and 50s, or within 10 years of menopause—hormone therapy is safe, effective, and protective. The real risk? Letting bad headlines guide our medical decisions.
As the authors write, it’s time to stop applying Band-Aids to a decades-old data wound and finally tell women the truth: estrogen doesn’t deserve the blame it’s carried for 20 years. And it’s past time to put the breast cancer myth to rest.
Dr. Aoife O’Sullivan is a family physician, board certified by the American Board of Family Physicians and a menopause specialist, certified by the North American Menopause Society, dedicated to empowering women through their midlife health journeys. She is the founder of Portland Menopause Doc, co-founder of the Portland Menopause Collective, podcaster on The Dusty Muffins, and an expert speaker, frequent podcast guest and active contributor to midlife women’s health research.
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