There was no bulge, after all. Without pain. If it weren’t for a routine mammogram, my life would still be going beautifully — I had a memoir coming out, a vacation in Italy to look forward to. But then I would remember the consultant’s grim expression as she took the breast tissue sample and was chilled from head to toe. I forced myself to be busy: folding washing, cooking, shopping, menial tasks to distract myself from the terror that descended cell by cell throughout my body, froze my skin, clenched my stomach . At the results appointment with a different doctor, I remember little other than the confirmation of cancer. My mind got into the word and I stopped taking much more. At the age of 54, Catherine Simpson (pictured) was told she had to stop taking HRT. The UK-based author was diagnosed with breast cancer that thrived on estrogen Later Lizzie the breast care nurse appeared with a pamphlet and explained that my cancer was “ER positive” which meant it was thriving on estrogen. Which also meant I had to stop hormone replacement therapy. He immediately said: the HRT was feeding my tumor. It felt like a second strike. Back home, I took the tablets from the kitchen shelf, but I couldn’t throw them away. I knew I could never take any more, but I couldn’t bear to let them go either. I was 54 and HRT had made me feel normal again. I had been on tablets for ten years after an early menopause at age 42, and they had taken away the hot flashes, the anxiety, the brain fog. They had stopped the panic attacks and palpitations that were interfering with my ability to care for the children. I had vowed that if any doctor ever tried to take my HRT away, I would get it online, go overseas, find the money to pay for it. I would beg, steal or borrow to get my hands on it. Back in 2008, when I was first prescribed HRT, early menopause was still a taboo subject. I felt ashamed, as if I had failed at something fundamental. I felt uncomfortable in the waiting room at the Edinburgh Women’s Health Clinic, too young to be there for this, as if someone had pressed the fast forward button on my life. A 2019 study in the Lancet reported a risk twice as high as previously thought, suggesting that around 5 per cent of all breast cancer cases in the UK are due to HRT So it was a relief to be offered such a simple solution. I was seen by an elderly female doctor who told me in no uncertain terms that taking HRT at my age was “no different to a diabetic taking insulin”. He said he would expect my body to still be producing these hormones, but since it wasn’t, it made sense to take them in pill form. I was aware of the research linking HRT to breast cancer, but I knew that research was controversial – and I found this experienced, confident, no-nonsense doctor reassuring. She was emphatic about the benefits of HRT. There was something about her disheveled hair and battered face that made her words seem more real, more believable. He was also telling me what I wanted to hear — that a pill could stop these horrible symptoms and also protect my bones, which I had already been told were thinning due to osteoporosis. That day, the thought of breast cancer was not mentioned. I left the clinic with my first box of HRT and have been taking it ever since.

How will taking HRT affect the risk of developing breast cancer? The answer is still far from clear. Here we gather the latest medical findings… Conflicting findings in recent studies have confused those who want to accurately assess risk. A 2019 study in the Lancet reported a risk twice as high as previously thought, suggesting that around 5 per cent of all breast cancer cases in the UK are due to HRT. The Oxford University research, now used as a basis for advice by the Government’s Medicines and Healthcare products Regulatory Agency, found an extra 20 cases of breast cancer per 1,000 women, aged 50 to 69, taking the most common form of HRT – combined oestrogens with daily progestogen — for five years. The number doubled for women who followed this regimen for ten years. This fell, however, to an extra 14 per 1,000 among those who took five years of consecutive HRT, with one week off per month of progesterone. In conclusion, the study also found that some risk continued for more than ten years after stopping HRT. and the means by which HRT was administered — via pills or transdermally as a gel, patch or cream — made no difference in risk. A 2020 study in the British Medical Journal was more reassuring, finding that for every 10,000 women on HRT, about 26 were likely to develop breast cancer as a result of the medication, and the risks dropped quickly after stopping it. So what is the consensus? “There is no doubt that HRT increases the risk of breast cancer,” says Professor Kefah Mokbel, chief breast surgeon at the London Breast Institute of the Princess Grace Hospital and consultant breast surgeon at St George’s Hospital in London. “But this risk is not very large and depends on many factors, including the type of HRT being taken. It is widely known that the safest form consists of estradiol taken transdermally, together with a natural micronized progesterone in an intermittent dose. Taking it like this for five years, one in 70 women will get breast cancer as a result.” Ten years later, I sat face to face with a doctor again, this time the surgeon who had cut the tumor out of my breast and sent lymph nodes to be tested to see if the cancer had started to spread. After a cancer diagnosis, it’s hard to absorb information. Appointments are short, doctors are busy, questions are difficult. you don’t know what you don’t know. So this time I had written questions, in a ridiculously tiny notebook with a holographic cover that I had won in a cracker. I have no idea what made me use it. I was psyched for bad news, but in the end it was good. the lymph nodes were clear and there would be no chemotherapy. My treatment would include three weeks of radiation therapy and the anti-estrogen drug tamoxifen, which I would take for ten years. The surgeon printed a prescription for me to go to the hospital pharmacy, and as he tapped away at his keyboard, I deciphered a word in my shiny firecracker notebook. He said: Why? ‘Why did I get this?’ I asked him. He grimaced to indicate there was no clear answer, then said, “Statistically speaking — (he uttered each syllable) — it was the HRT that caused it, but we’ve never been able to prove it. I learned later that there is a name for this kind of thing: iatrogenic disease. An illness caused by medical intervention, because I thought he was right. it was HRT. After all, there was no family history of breast cancer and I had been taking the drug for ten years. a long period that increases the risks. I left the consultant’s office with an anti-climactic mixture of numbness and shock. I felt punch-drunk. While waiting for the tamoxifen, I bought a coffee and posted on Facebook: No need for chemo and radiation should be done by Christmas. Bloody great. Party at the cafe… Wonderful? Is he celebrating? What terrible lies we tell on social media. At home, I reached into the top shelf of the kitchen and found the HRT packet I couldn’t bear to throw away. That was the drug that probably gave me cancer. I fished out the brochure, a thin thin strip of paper that, when straightened, was over 3 feet long. As usual, there was an extensive list of possible side effects: ovarian cancer, endometrial cancer, blood clots, heart disease, stroke, but at the top of the list was breast cancer. “Evidence suggests that taking combined oestrogen-progestagen and possibly also oestrogen-only HRT increases the risk of breast cancer. The extra risk depends on how long you have been taking HRT. The additional risk becomes clear within a few years.’ There was a shaded box titled ‘Comparison’, which said: ‘Of women aged 50 to 79 who do not take HRT, an average of nine to 17 in 1,000 will be diagnosed with breast cancer over a five-year period. For women aged 50 to 79 years taking oestrogen-progestogen HRT for five years, there will be 13 to 23 cases per 1,000 users (ie an extra four to six cases). I had never read this pamphlet before. Who expects it to be one of the extra four to six cases in 1,000? Who expects to be so unlucky? Certainly not me. especially as I was only 44 when I started taking HRT, and yet it’s obvious that someone must be so unlucky. And if not me, then who? Once I stopped taking the HRT, the hot flashes came back, but they were only one or two a day and bearable. But then I started tamoxifen, which made my estrogen levels disappear, and it was a different story. Women aged 50 to 79 who do not take HRT, an average of nine to 17 in 1,000 will be diagnosed with breast cancer over a five-year period The flushes became wild and almost constant. They started as a sensation in my sinuses, a pressure in my head, a shifting and stabbing around the eyes, a thump in the roof of my mouth, all of which quickly became dizzying in intensity. The searing heat creeping over my body was overwhelming, and in an enclosed space—a theater seat or bus—the suffocating sensation would threaten a panic attack. I scoured the Internet for advice on hot flashes: Go to bed in a wet shirt (a “treatment” surely as dangerous as the disease), don’t layer or layer. And the most consistent tip? Take HRT. One year after my cancer diagnosis, the summer of…