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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 . . . [Full Text of this Article]

Wulf H. Utian, MD, PhD
Cleveland Clinic Foundation
Cleveland, Ohio

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