Hormone replacement therapy: boon or bane?

The steadily increasing frequency of breast cancer, especially in elderly women, may be owing to the following three factors, among others: natural aging, the increased use of mammography leading to earlier diagnosis of in-situ carcinoma and occult carcinoma, and the indiscriminate use of hormone replacement therapy (HRT). That there is a correlation of estrogen with breast cancer cannot be refuted. Early menarche, late menopause, late first pregnancy, obesity and dietary factors are directly or indirectly connected with an increased likelihood of breast cancer. The recent flurry of interest in attempting to prevent osteoporosis-induced bony fractures and coronary artery disease among elderly women has not been fully tested as to its efficacy by a scientific, prospectively randomized clinical trial. Therefore, it seems timely to indicate clearly that the use of HRT should be made on an individual basis, with the tacit understanding and approval of the patients, some of whom are symptomatic but the majority of whom have no signs or symptoms of the diseases for which prevention is being advocated.