To the Editor: Dr Anderson and colleagues,1 for the Women's Health Initiative, reported that continuous combined estrogen plus progestin therapy may increase the risk of ovarian cancer while producing endometrial cancer rates similar to placebo. However, this conclusion does not reflect their findings. The prematurely terminated estrogen plus progestin arm had an observed annual incidence rate of 34 ovarian cancer cases per 100 000 person-years, somewhat less than the anticipated population-based rate of 45 per 100 000 person-years. The ovarian cancer rate in the estrogen plus progestin group "was elevated (20 vs 12; HR, 1.58; 95% CI, 0.77-3.24 [adjusted 95% CI, 0.59-4.23]), but not statistically significant." Nor did the Kaplan-Meier estimates of cumulative hazards reach statistical significance.
With regard to the risk of endometrial cancer, the observed incidence rate for the estrogen plus progestin group was 62 per 100 000 person-years, which is also lower than the anticipated population-based rate of 83 per 100 000 person-years. The authors stated that "a small, nonsignificant reduction in endometrial cancer risk was observed with estrogen plus progestin use (27 vs 31; HR, 0.81; 95% CI, 0.48-1.36 [adjusted 95% CI, 0.40-1.64])." Thus, although the authors were willing to claim that the nonsignificant difference in ovarian cancer suggests increased risk, they did not conclude that a similar nonsignificant reduction in endometrial cancer suggests a decreased risk.
Because the discrepency between the findings and conclusions is confusing, my interpretation of these data is that neither ovarian nor uterine cancers should be considered when determining a patient's benefit-to-risk ratio for hormone therapy.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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