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To the Editor.—
I was quite surprised by the conclusions that were drawn by Hulka and co-workers from a small sample of patients (79 patients with endometrial carcinoma and 203 control subjects) in an article published recently in The Journal (1982; 247:475). The very factors that predisposed to endometrial carcinoma— hypertension, diabetes, and obesity— are also factors that are relative contraindications to the use of oral hormonal contraceptive agents. Perhaps the reason that fewer women in the endometrial cancer cohort had taken oral contraceptive agents was that their clinicians chose some other method of contraception as more suitable in the hypertensive, diabetic, and obese individual. This would seem to provide a more logical explanation of why fewer individual patients with endometrial cancer had been using oral contraceptive agents, rather than to indicate that the oral contraceptive agents had a protective effect against cancer. The authors' published data are incomplete, in
Evrard JR. Protection Against Endometrial Carcinoma by Combination-Product Oral Contraceptives. JAMA. 1982;248(6):647–648. doi:10.1001/jama.1982.03330060015016
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