May 21, 1997

Estrogen Replacement Therapy: New Options, Continuing Concerns-Reply

Author Affiliations

Yale University School of Medicine New Haven, Conn

JAMA. 1997;277(19):1516-1517. doi:10.1001/jama.1997.03540430028020

In Reply.  —Dr Atkins interprets the findings of Cauley et al as evidence that HRT for the treatment of osteoporosis will increase the risk of breast cancer. This view differs from that of Cauley et al, who state that HRT "may not increase the risk of breast cancer" in women with osteoporosis who "have had relatively low endogenous estrogen levels" but may, instead, increase the risk for women with "normal or high endogenous estrogen [who] take exogenous estrogen for other indications (eg, to prevent cardiovascular disease)."The posited relationship between BMD, HRT, and breast cancer risk is complex, as highlighted by the fact that African-American women have higher bone densities and a lower risk of breast cancer than white women,1-3 indicating that factors other than, or in addition to, estrogen influence both breast cancer risk and bone density. In addition, as we noted in our Editorial, data on past HRT use