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Hormone Replacement Therapy and Risk of Breast Cancer

Ellen C. G. Grant, MD
JAMA. 2002;287(18):2360-2361. doi:10.1001/jama.287.18.2359.
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To the Editor: Dr Chen and colleagues1 found that use of hormone replacement therapy (HRT) for 20 to 60 months within the previous 5 years increased the incidence of breast cancer by 60% to 85%. They also found that current use of estrogens doubled the risk of lobular breast cancer, but current use of estrogen plus progestin combination increased the risk 4-fold, or twice as much again.

It would be of interest to know how many women in this study had never used hormones. Did ever-users of both HRT and oral contraceptives (OCs) have more hormone receptor–positive cancers? Similarly, Chen et al did not measure the effect of very short HRT use because women receiving a single 3-month supply were excluded. However, prescription data in the United Kingdom suggest that most women take HRT for only 9 months.2 One UK study of HRT excluded women who did not complete a year of therapy.3 In contrast, another UK study found that 1-year use of progestin-only contraceptives increased the risk of breast cancer by 35%, with few women having longer use.4


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