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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