Estrogen Replacement Therapy in Breast Cancer Survivors

To the Editor.  —We wholeheartedly applaud the suggestion by Dr Cobleigh and colleagues¹ that the role of ERT in the care of postmenopausal women with a history of breast cancer should be defined in a thoughtful and broad-minded manner through carefully designed prospective clinical trials. The realization that omission of the ERT option may no longer be appropriate for all women previously treated for breast cancer has led us to initiate such a prospective study, as the authors point out.² During our interactions with postmenopausal women with prior diagnosis of breast cancer, both within our institution³ and in the community, we are impressed by their compelling descriptions of the deleterious effects of estrogen deficiency on their sense of well-being. The principle that no one medical intervention is ever appropriate for all individuals appears intuitively obvious but merits repetition. We would like to caution that neither ERT nor