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Dr Evrard raises the possibility that the findings from our study could be an artifact. If obesity, hypertension, and diabetes are contraindications to prescribing oral contraceptives and these characteristics are also overrepresented among women with endometrial carcinoma, then the low frequency of oral contraceptive use among patients with endometrial cancer could be attributed to physicians' hesitation to prescribe these products to women who have the characteristics that subsequently lead to endometrial cancer.We did explore this possibility, as noted in the "Analyses" section of our article. These characteristics and others were evaluated for their possible confounding effects on the association between endometrial cancer and lack of oral contraceptive use. They did not account for the association. However, to make this point more clearly, we have repeated the analysis of endometrial cancer risk in relation to oral contraceptive use excluding women who were hypertensive, diabetic, or obese. Thus, any
Hulka BS, Chambless LE. Protection Against Endometrial Carcinoma by Combination-Product Oral Contraceptives-Reply. JAMA. 1982;248(6):648. doi:10.1001/jama.1982.03330060015017