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January 7, 2004

Hormone Therapy and Risk of Gynecologic Cancers—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(1):42. doi:10.1001/jama.291.1.43-a

In Reply: In response to Dr Utian, we acknowledged that the estimated effects of estrogen plus progestin on endometrial cancer and ovarian cancer did not reach statistical significance. The fact that these data arose from the only randomized, double-blind, placebo-controlled trial of sufficient size and duration to examine effects on these rare gynecologic cancers makes them a unique, although still not definitive, contribution to the literature.

The comparison of the cancer rates within the Women's Health Initiative trial to population-based rates is irrelevant to understanding intervention effects. Participants in randomized trials typically have lower event rates than the general population—the so-called healthy-volunteer effect. In this case, the comparison is further confounded by many other factors including considerable exposure to hormone therapy in the general population.

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