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In Reply. —
Dupont suggests that the increased risk of breast cancer among current users of estrogen replacement therapy may be due, in part, to greater surveillance and early detection, basing this hypothesis on our crude rates of breast cancer. As shown in Table 2 of our article, age is strongly related to use of estrogen therapy and hence confounds the simplified analysis of Dupont; using age-adjusted data, we found a 36% excess risk among current estrogen users, not a 20% excess as he claims. Further, the difference in the prevalence of mammography was 15% (64% in current estrogen users and 49% in nonusers—not 31%), and the distribution of tumor size at diagnosis was similar across categories of use of estrogen therapy (an excess of small tumors would be expected among estrogen users if our findings were an artifact). Thus, as we indicated in greater detail in our discussion, surveillance
Colditz GA, Stampfer MJ, Willett WC, Speizer FE, Hennekens CH, Rosner B. Estrogen Replacement Therapy and Risk of Breast Cancer-Reply. JAMA. 1991;265(14):1825. doi:10.1001/jama.1991.03460140052015