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When Valerie Beral was a young family planning doctor, there was no reliable evidence about the health effects of various contraceptive choices. Her uncomfortable inability to answer women’s questions satisfactorily helped lead her to become the epidemiologist who, over several decades, generated much of the world’s best evidence on hormonal factors and female cancers. She re-analysed detailed data from virtually all relevant studies in the world (the largest being her own UK Million Women Study). The overall results showed that some years of oral contraceptive use slightly decreased cancer rates (as it protected against ovarian and endometrial cancer, with little effect on breast cancer), facilitating family planning decisions. They also showed, however, that a few years of menopausal hormone therapy somewhat increased breast cancer rates.
Her frustration with the lack of consensus regarding the hypothesised effects of oral contraceptives led her to form worldwide collaborations between all who had undertaken epidemiological studies of hormonal factors and cancers of the breast, ovary, endometrium or cervix, bringing together virtually all the relevant data. Her judicious and painstaking analyses of the data provided definitive evidence that pill use has little effect on a woman’s lifelong risk of breast cancer, but offers significant long-term protection against ovarian and endometrial cancer. This has directly or indirectly given hundreds of millions of women more freedom to choose whether or when to have children, safe in the knowledge that they are not increasing their overall cancer risk.
Using a similar approach, Professor Beral showed that the adverse effects of menopausal hormone therapy (MHT) on cancer had been underestimated, and that some years of MHT had in fact caused an appreciable increase in breast cancer risk. Although her work on the risks and benefits of MHT use over the last two decades has influenced public and medical opinion, preventing many thousands of cases of breast cancer, MHT use is again rising in the UK. As MHT preparations had varied over time, she sought definitive evidence about the effects of contemporary MHT preparations by establishing the Million Women Study, which included about a quarter of all UK women aged 50-64 in the late 1990s and ever since then has used anonymised NHS records to monitor their illnesses. This lasting resource for research into women’s health is still providing definitive evidence about the determinants of many common diseases. It has shown that ‘if women smoke like men they die like men’ (to quote her 2013 press statement), but has also exploded many of the widely publicised but unjustified claims about supposedly healthy or hazardous habits.
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