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Estrogen Replacement Therapy and Risk of Breast Cancer-Reply

Graham A. Colditz, MB, BS; Meir J. Stampfer, MD; Walter C. Willett, MD; Frank E. Speizer, MD; Charles H. Hennekens, MD; Bernard Rosner, PhD
JAMA. 1991;266(10):1357-1358. doi:10.1001/jama.1991.03470100049016.
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In Reply.  —We appreciate the concern expressed by Drs Bush and Helzlsouer regarding the elevated risk of breast cancer among women currently using estrogen replacement therapy. They raise the question of differential rates of mammography among the women who are current users of postmenopausal hormones (64%) compared with nonusers (49%). Actually, this modest difference in rates initially concerned us as well. After a detailed examination, we concluded that it cannot explain the association between estrogen use and breast cancer incidence. As of 1988, among women in the Nurses' Health Study who reported having a mammogram, two thirds indicated that they had had more than one previous mammogram, suggesting that the population is approaching the steady state in which mammography increases lead time but not the total number of cases of breast cancer that are diagnosed. In the Health Insurance Plan on New York,1 after 5 years, the excess incidence


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