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February 24, 1993

The Postmenopausal Estrogen/Breast Cancer Controversy

JAMA. 1993;269(8):990. doi:10.1001/jama.1993.03500080038024

To the Editor.  —To help resolve the conflict in the literature regarding the association of postmenopausal hormone therapy and breast cancer, Henrich1 reviewed three meta-analyses. We are concerned that the data reported in that article were incomplete, inaccurate, and misleading.Two recently published meta-analyses are not included in this review.2,3 The author correctly concludes that none of the meta-analyses (including the two that were not reviewed) found an increased risk of breast cancer associated with ever use of estrogen. The median duration of estrogen use is brief, generally about 2 years.4 Thus, risk estimates for women who ever used estrogen should really be interpreted as risk among short-term estrogen users. Since hormone replacement is now commonly prescribed for 10 to 20 years or more to prevent osteoporosis and heart disease, we must also ask if long-term estrogen use is associated with increased breast cancer risk.The author