Chains of evidence, mosaics of data: does estrogen 'cause' breast cancer? How would we know?

There appears to be a broad consensus that estrogen is a cause of breast cancer. Proof of cause and effect in clinical medicine requires a different approach for an epidemiological exposure (a 'mosaic' approach) than for an infectious agent suspected of causing a particular disease (a ...

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Bibliographic Details
Published in:Climacteric : the journal of the International Menopause Society 2012-12, Vol.15 (6), p.531-537
Main Authors: Bluming, A. Z., Tavris, C.
Format: Article
Language:English
Subjects:
BREAST CANCER
Breast Neoplasms - chemically induced
Breast Neoplasms - epidemiology
Causality
CAUSATION
Epidemiology
ESTROGEN
Estrogen Replacement Therapy - adverse effects
Estrogens
Estrogens - adverse effects
Evidence-Based Medicine
Female
HORMONE REPLACEMENT THERAPY
Humans
Risk Factors
Women's Health
Womens health
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Summary:There appears to be a broad consensus that estrogen is a cause of breast cancer. Proof of cause and effect in clinical medicine requires a different approach for an epidemiological exposure (a 'mosaic' approach) than for an infectious agent suspected of causing a particular disease (a 'chain of evidence' approach). This paper discusses the differences between these two approaches in determining the relationship between a risk factor and a disease, and assesses the strength of the data linking estrogen with breast cancer. Analysis of existing data, including findings from the Women's Health Initiative, finds that all nine of the criteria necessary for confirming the epidemiological strength of a risk factor are not met in the case of estrogen, raising serious questions about the validity of this widespread assumption.
ISSN:1369-7137
1473-0804
DOI:10.3109/13697137.2012.678915