The workshop was organised in such a way as to provide a forum for

1 Introduction to the Presentations

M.A. Lewis

From 27 to 29 August 2003, a group of scientists, all leaders in their field, met to discuss the status of hormone replacement therapy (HRT) follow- ing the results of recent epidemiological studies which had surprisingly indicated the presence of cardiovascular and in particular breast cancer risks associated with HRT. The meeting was convened in the picturesque setting of the Andechs cloister in Bavaria. Its purpose was to discuss all aspects of HRT use independent of pharmaceutical manufacturers and to provide a state-of-the-art assessment of the issues related to HRT risks.

The workshop was organised in such a way as to provide a forum for

all features of hormone replacement therapy, some of which went be-

yond the specific issue and addressed issues related to drug treatment in

general. Thus the contributions to the workshop included presentations

of such general import as the definition of the term “responsibility” for

both of the manufacturer of medicines and the prescriber (see Profes-

sor Poser’s paper), risk perception and risk communication (Heilmann),

as well as the historical (Teichmann) and practical (Schneider) aspects

of HRT use and prescription. Epidemiological results and issues were

addressed by Heinemann, Lidegaard, and Shapiro. The specific areas

of concern, i.e. those disease entities for which association was found

among HRT users, such as endometrial cancer (Horn), colon cancer and

ovarian cancer (Dietel), breast cancer (Böcker), and cardiovascular dis-

ease (Windler), were independently addressed. The list of participants

4 M.A. Lewis

shows that it includes internationally renowned experts in gynaecology, pathology, epidemiology and biostatistics who did not prepare a formal presentation. While the presentations were important to lay the ground- work for the ensuing discussions, the most important aspect of the workshop was the insights developed in the interactions of all workshop participants.

The scope of the workshop was, therefore, broad and encompassing, it was informative to the participants, and, unlike many workshops of this nature, it was conclusive. It was structured to provide background information for each discipline, so that all participants were informed of the current status in each of the research areas on the 1st day of the event.

The 2nd day was designed to establish an interdisciplinary consensus of conclusions regarding the meaning of the data and the most appropriate steps to be taken to resolve issues that remain unclear.

The following pages revisit the 2 days of this memorable workshop.

The first day focussed on the presentations. Because many presentations

were in German, the reports are preceded by summaries reflecting the

understanding of this author at the time they were given, taken from the

notes made at that time, and the main discussion points. The 2nd day

focussed on the discussions and interactions between participants and

on the development of a common view; each is preceded by a brief sum-

mary. The salient discussion points and the final workshop conclusions

are presented. Overall, it is hoped that the juxtaposition of presentations

and discussions will provide insight into how the views expressed in the

workshop’s conclusions developed among the workshop participants.