Hormone replacement therapy: decision making in an age of uncertainty

The burgeoning epidemic of breast cancer has led to further scrutiny of the relationship between it and estrogen replacement therapy. While, according to multiple analyses, the relative risk of breast cancer in estrogen users seems to be only slightly increased over 1.0, the risk is not evenly distributed among various populations of women. In clinical practice, doctors are not certain which of their patients are prone to develop breast cancer and which are not. Still, the physician confronts the need to make practical decisions about hormone administration. A decision tree is presented in this paper to facilitate the choice and to help the practitioner in reconciling two seemingly contradictory medical precepts.