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August 9, 2000

Estrogen-Progestin Replacement and Risk of Breast Cancer

Author Affiliations

Stephen J.LurieMD, PhD, Contributing EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(6):691-694. doi:10.1001/jama.284.6.691

To the Editor: Dr Schairer and colleagues1 reported an increase in RR of breast cancer with the use of estrogen-progestin therapy compared with estrogen use alone. This increase in RR associated with progestin use may be reflected in the mammographic density changes seen with HRT.

Breast density increases in many women undergoing HRT. Among women undergoing continuous estrogen-progestin therapy, 27% had an increase in breast density, compared with 10% of those using cyclic combined therapy, and only 5% of women using estradiol alone.2 Likewise, in premenopausal women, the breasts are more radiographically dense during the luteal phase than the follicular phase of the menstrual cycle3 when progesterone levels are highest. Conversely, use of tamoxifen citrate, which decreases breast cancer risk, is associated with a decrease in mammographic density.4

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