To the Editor: Dr Rodriguez and colleagues1 suggest that if others confirm their findings, a possible increase in risk of dying from ovarian cancer should be added to the list of possible estrogen-related adverse effects to be discussed with patients considering HRT. They based this recommendation on finding that 31 women died from ovarian cancer among women who in 1982 self-reported using HRT for 10 years or more. This is a relatively small number of events, which weakens the reliability of the conclusions. In addition, other reports on the effect of HRT use on ovarian cancer risk are inconsistent. Of the 5 case-control studies cited by Rodriguez et al that measured ovarian cancer risk among women who used HRT for 5 or more years, 4 found no statistically significant difference.2- 4 One study found a statistically significant increased risk of endometrioid ovarian adenocarcinoma among women who used unopposed estrogen (OR, 2.81; 95% CI, 1.15-6.89).5 For the more common serous carcinomas, the OR of 2.03 was barely statistically significant (95% CI, 1.04-3.97). A recent meta-analysis reported no association between HRT use and ovarian cancer.6
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