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To the Editor: Dr Schairer and colleagues¹ conclude that the estrogen-progestin regimen is associated with higher risks of breast cancer than estrogen alone. However, several aspects of the study deserve careful consideration.

First, the study was not conducted in a representative sample of women but in a select population for whom the risk of breast cancer may be high. Only a sample of women who had neither surgery nor the recommendation for it at baseline were included in the analysis. Furthermore, type of hormone used was not assessed in the first phase of follow-up. Some hormone use was measured retrospectively, possibly introducing recall bias.² Moreover, the authors report no results for women who had mammography regularly.

An analysis excluding cases of breast cancer that occurred in the first phase of the study would address the possibility of surveillance bias. An analysis of events by follow-up phase would add to a . . . [Full Text of this Article]

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