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Valerie Beral: epidemiologist, academic, and eminent specialist in breast cancer epidemiology

BMJ 2022; 378 doi: (Published 21 September 2022) Cite this as: BMJ 2022;378:o2271

Rapid Response:

Re: Valerie Beral: epidemiologist, academic, and eminent specialist in breast cancer epidemiology

Dear Editor

I was saddened to read of the death of Professor Dame Valerie Beral. We first met her when she was at the LSHTM before she went to Oxford. At that time endometrial cancers had increased due to Oestrogen only HRT.

In 2004 when the randomised double blind WHI studies were terminated early because of proven increases in breast cancer and vascular diseases, HRT use in Westernised countries fell from 36 to 12 million (V Beral Lancet 2019).[1] The Collaborative Group on Hormonal Factors in Breast Cancer reviewed all the available relevant randomised evidence and found a significant nearly double increased risk of breast cancer with use of micronized progesterone (RR 1.93 (1.84-2.01).[1] The progesterone used is micronized to aid alimentary absorption and produce a more powerful effect from an oral dose. Many young women are being given progesterone or Pill progestogens again as HRT although the risk of breast cancer and breast cancer mortality doubles after a total lifetime's exposure of only 5 years.

Decreased hormone use quickly lowers incidences of breast and ovarian cancers in hormone taking countries.[2-4]

Colonel Sir George Thomas Beatson remitted metastatic breast cancer in 1896 by removing functioning ovaries to prevent endogenous secretion of oestrogens and progesterone. Oophorectomy became the standard treatment for advanced breast cancer and Beatson is considered the father of anti-hormonal treatment of breast cancer.

1 Collaborative Group on Hormonal Factors in Breast Cancer. Type and Timing of menopausal therapy and breast cancer risk individual participant meta-analysis of the worldwide epidemiological evidence. Lancet 2019;394 1159-68.

2 Grant ECG. Reduction in mortality from breast cancer: fall in hormone use could have reduced breast cancer mortality. BMJ. 2005 Apr 30;330(7498):1024.

3 Grant ECG Oral contraceptive progestin and estrogen use and increases in breast, ovarian and endometrial cancers. JAMA Oncol. 2018 Sep 13. doi: 10.1001/jamaoncol.2018.4146. [Epub ahead of print].

4 Grant ECG. Lifetime cancer risk with progestin and estrogen oral contraceptives and hormone therapy. Am J Obstet Gynecol. 2017 Aug;217(2):232-233. doi: 10.1016/j.ajog.2017.05.005. Epub 2017 May 11.

Competing interests: No competing interests

24 November 2022
Ellen CG Grant
Physician and medical gynaecologist
Kingston-upon-Thames, Surrey