ESTROGEN AND BREAST CANCER

A statistics-laden, fact-filled chronicle linking the increasing use of estrogen with the growing incidence of breast cancer, plus some solid ideas about remedying the situation. Medical writer Rinzler (Cosmetics, 1977, etc.) adeptly wends her way through a host of scientific studies, translating them into lay language and sorting out their implications. Her take- home message: The estrogen in oral contraceptives, used by millions of young women, and in hormone-replacement therapy, used by millions of older women, promotes the growth of existing tumors and may initiate cancers in susceptible women. Rinzler's story essentially begins with legal approval of the Pill in 1960, but there's also a brief look at how female medical problems were treated in earlier days, including some fascinating medical lore- -e.g., that in 1934, the Merck Manual, a standard reference book of current medical opinion, listed cannabis as a treatment for the symptoms of menopause. Rinzler generally lets the facts speak for themselves, offering no shrill diatribe against pharmaceutical companies or physicians, no easy indictment of the medical establishment. The picture she creates is more complex, since powerful medications such as estrogen are never risk-free, and the benefits always must be weighed against the dangers. Overall, Rinzler's criticisms are validated and her recommendations restrained: Women must be told the truth about estrogen, and those at risk for cancer must be identified; the rules for prescribing estrogen must be tightened; safer alternatives must be found. If the author meets her aim, women won't abandon the Pill or hormone-replacement therapy, but will ask critical questions of their physicians and make informed decisions about the risks they're willing to take. Straight talk—informative and accessible—about a health issue of concern to millions.