Reviewed by: Estrogen and Breast Cancer: A Warning to Women Diana E. Long Carol Ann Rinzler. Estrogen and Breast Cancer: A Warning to Women. New York: Macmillan, 1993. xiv + 233 pp. $22.00. Breast cancer is an appalling reality in the lives of women, a reality that we want scientific medicine to change, or at least not to exacerbate. One out of eight or nine women in America dies from breast cancer, a mortality that has been rising since the war on cancer was undertaken in 1965. Why? This book takes up one theory, that the estrogen prescribed by physicians as birth control or as an antidote to menopause increases the risk of breast cancer. While arguing this case, Carol Rinzler also insists on another: women must be skeptical about their physicians’ prescriptions and take them with large grains of historical insight and statistical data. On the first subject, the author is arguing a cause, in both senses. The book opens with a history of the development and uses of estrogen in medicine, from its naming as “the female principle” in the 1920s to its development as a remedy for menopause, reproductive ills, and pregnancy in the 1930s. She then traces the problems with the Pill since that time, and the rise of Estrogen Replacement Therapy for menopause, concluding with a section on “an inference of blame” that followed the reports in the late sixties that high-dosage estrogen pills caused blood clots and other disabilities. With that teaser she moves on to cancer with some “Definitions, Statistics and Studies” of cases and the vital connection of “Hormones and Cancer.” She specifies the warnings, official truths, and victims of “the pill and breast cancer” and of Estrogen Replacement Therapy and breast cancer, before laying out an agenda for women—for their rights and their lives—that invites individual decision making. Rinzler interprets these data as a demonstration of a tight link between the prescription of estrogen and an increased risk for breast cancer. This was a controversial subject when she wrote this book in the early 1990s and it has only become more confusing. The Harvard Nurses’ study of 1992 stated that “the [End Page 557] current use of estrogen increases the risk of breast cancer to a modest degree, and that the addition of progesterone does not remove the increased risk.” 1 By 1995, the Study stated more clearly that “the addition of progestins to estrogen therapy does not reduce the risk,” which is “substantial” for older women. 2 Rinzler’s history and her attitude toward the steroid seem justified by this study. But other studies have concluded that there is little or no danger from the hormones, and have given evidence that estrogen protects women from heart disease, osteoporosis, and perhaps other cancers. The woman who tries to read these tea leaves is very confused, and most women either just make a guess about their own trade-offs or follow their physician’s advice. Rinzler’s real goal is to jolt women out of that passive stance toward professionals. Her historical study is enough to give a woman, or a policymaker, pause. She insists that it is time to ask the question: Why are these people in such a hurry to experiment with our bodies? They say they are responding to our calls for relief from hot flashes, and our recognition of the benefits of estrogen in the statistics on heart disease and osteoporosis. Those who advocate estrogen in the Pill and at menopause say, “Yes, there is a slight risk but there are other benefits of taking the pills.” Critics, like Rinzler, reply, “Yes, and any risk is significant when the disease is breast cancer.” Yet she does not want women to follow her authority, but to figure out their own best interests. Whom do you trust in making such life-threatening decisions? I can remember telling a very eminent Boston gynecologist in the 1970s that his eagerness to get rid of my “useless organs” disqualified him to be my physician. (I think I actually said, “You keep your useless organs, and I will keep mine.”) But such brave and clear moments are few, even for dedicated...