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May 8, 2002

Hormone Replacement Therapy and Risk of Breast Cancer—Reply

JAMA. 2002;287(18):2360-2361. doi:10.1001/jama.287.18.2359

In Reply: Dr Grant is concerned that OCs and short-term HRT may increase the risk of breast cancer. In our study, there was no association of OC use with breast cancer risk (Table 1), and no association of HRT use of up to 18 months' duration (Table 2). Therefore, we believe that it was appropriate to include both OC users who did not use HRT and users of HRT for less than 3 months in the reference group of non-HRT users.

We appreciate Dr Stadel's concern that the association of HRT with breast cancer appeared to be stronger for women with surgical menopause than for women who had natural menopause. We did not highlight those differences because based on a statistical test for interaction, those apparently large group differences were consistent with chance. On inspection, the trend across the HRT use groups is similar (ie, using the <18-month HRT group as the reference) for the 2 menopause categories. Thus, the difference is due to variability between the 2 reference groups (nonusers of HRT with natural vs surgical menopause).