In Reply: Dr Grant is concerned that OCs and
short-term HRT may increase the risk of breast cancer. In our study, there
was no association of OC use with breast cancer risk (Table 1), and no association
of HRT use of up to 18 months' duration (Table 2). Therefore, we believe that
it was appropriate to include both OC users who did not use HRT and users
of HRT for less than 3 months in the reference group of non-HRT users.
We appreciate Dr Stadel's concern that the association of HRT with breast
cancer appeared to be stronger for women with surgical menopause than for
women who had natural menopause. We did not highlight those differences because
based on a statistical test for interaction, those apparently large group
differences were consistent with chance. On inspection, the trend across the
HRT use groups is similar (ie, using the <18-month HRT group as the reference)
for the 2 menopause categories. Thus, the difference is due to variability
between the 2 reference groups (nonusers of HRT with natural vs surgical menopause).
White E, Chen C. Hormone Replacement Therapy and Risk of Breast Cancer—Reply. JAMA. 2002;287(18):2360-2361. doi:10.1001/jama.287.18.2359