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To the Editor: Dr Lacey and colleagues¹ reported an increased risk of ovarian cancer in women who used unopposed estrogen, but not among women who used an estrogen-progestin combination. However, the histology of these tumors was described for only one third of the cases. A significant difference was found only for endometrioid cancers. Another study had similar findings, with only a significant increase in endometrioid and clear cell epithelial cancers among women receiving unopposed estrogen.² In that study, the risk was greater in women who had received a tubal ligation or a hysterectomy, thus suggesting a possible role of estrogen-stimulating endometriosis.

However, the data concerning the risk of estrogen and ovarian cancer are not consistent. A recent meta-analysis did not find an association between estrogen replacement therapy (ERT) and ovarian cancer.³ The literature suggests that the risk, if any, may be confined to specific histologic subgroups of ovarian cancer.

There . . . [Full Text of this Article]