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August 11, 2004

Effects of Estrogen-Only Treatment in Postmenopausal Women

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292(6):683. doi:10.1001/jama.292.6.683-b

To the Editor: In their landmark trial the WHI group1 presents a surprisingly steady decreased risk of breast cancer among women using CEE compared with the placebo group. Although the result is not statistically significant, we tried to seek an explanation for this unanticipated finding. As expected, prior hormone use among these women with hysterectomy was high (48%) and long duration of use was common (28% for 10 years or more among ever-users). Since most observational studies have found an increasing breast cancer risk for recent users with longer lifetime use of estrogen-only preparations,2 it would be interesting to see what happens if data are stratifed for these aspects of prior use. In addition, many women underwent an oophorectomy (39.5% in the intervention group and 42% in the placebo group), which may reduce their breast cancer risk by more than half.3 Clearly, an oophorectomy will be related to long-term prior hormone therapy. The power will be limited to take both prior hormone use and a history of oophorectomy into account, but a description of the data in this context would be very informative.

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