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July 12, 1995

Hormone Replacement and Breast CancerA Remaining Controversy?

Author Affiliations

From the Departments of Cancer Epidemiology (Drs Adami and Persson) and Obstetrics and Gynaecology (Dr Persson), University Hospital, Uppsala, Sweden, and Department of Epidemiology, Harvard University, Boston, Mass (Dr Adami).

JAMA. 1995;274(2):178-179. doi:10.1001/jama.1995.03530020096039

Ever since replacement hormones were introduced some 30 years ago, there has been concern regarding a possible adverse effect on breast cancer risk. More than 30 epidemiological studies have explored the relationship between exogenous hormones and breast cancer. Most of them were of case-control design,1-3 while seven were prospective cohort studies.4-10 Despite several attempts to summarize available evidence in overviews1 and through meta-analyses,2,3 there is still considerable uncertainty as to whether replacement hormones increase breast cancer risk. However, some recent studies indicate that long-term intake of conjugated estrogens or estradiol compounds is associated with a moderate risk increase.6,8,11-13 The remaining controversy might be viewed as a shortcoming of the epidemiological method, ie, inability to clarify the role of a potential cause of breast cancer. According to a rival and more optimistic interpretation, the absence of unequivocal evidence for a risk-increasing effect of replacement hormones indicates

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