We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Letters |

Relationship Between Postmenopausal Hormone Replacement Therapy and Ovarian Cancer—Reply

Carmen Rodriguez, MD, MPH; Eugenia E. Calle, PhD; Eric J. Jacobs, PhD; Alpa V. Patel, MPH; Michael J. Thun, MD, MS
JAMA. 2001;285(24):3089-3090. doi:10.1001/jama.285.24.3089.
Text Size: A A A
Published online


In Reply: The findings of Dr Bosetti and colleagues support the association that we observed between ovarian cancer and HRT use. In both analyses, the increased risk diminished after cessation of use. The critical question for clinical practice continues to be whether estrogen and progestin in combination or only unopposed estrogen use affects ovarian cancer risk.

We agree with Dr Hernandez that the data relating ovarian cancer to ever users of HRT are inconsistent. Case-control studies assessing ovarian cancer risk with 5 or more years of HRT use, however, have consistently reported increased risk, as we mentioned in our article. Nevertheless, we agree with Hernandez that the current evidence is incomplete and does not warrant an immediate change in clinical practice. Hernandez does, however, raise a more general and relevant question. When is the evidence from observational data sufficient to change medical practice? In the case of postmenopausal HRT, appropriate guidelines for individual women ultimately should be based on a full understanding of the balance between risk and benefits. Hernandez states that the association between postmenopausal HRT and breast and ovarian cancer is controversial. While we agree with this statement as it relates to ovarian cancer, we believe that the positive association between breast cancer and HRT use has been clearly established.1,2 Results from the Women's Health Initiative Trial will help clarify the impact of HRT use on risk of cardiovascular disease, osteoporosis, and breast cancer. The effect of postmenopausal HRT use on relatively rare diseases, such as ovarian cancer, cannot be studied with randomized trials and will likely only be evaluated through epidemiologic studies.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.