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To the Editor: The Women's Health Initiative (WHI) investigators¹ found that use of conjugated equine estrogen (CEE) was associated with a decreased risk of breast cancer among women with prior hysterectomy. However, the trial was discontinued early and I do not feel that this early termination was justified, given that the cumulative hazard ratio (HR) of 0.77 (95% confidence interval [CI], 0.59-1.01) narrowly missed statistical significance. It would have been important to study the effects of additional years of treatment, as knowledge of hormone-dependent cancers remains incomplete.

A comparison of the WHI data on the effect of estrogen alone and estrogen combined with progestin suggest that progestins may counteract a possible protective effect of estrogen.^1-2 It remains possible, however, that these results may be related to selection bias, given that combined estrogen and progestin had no effect on breast cancer risk: both the never-users and the women receiving hormone therapy . . . [Full Text of this Article]

Herbert Kuhl, MD
h.kuhl@em.uni-frankfurt.de
Department of Obstetrics and Gynecology
University of Frankfurt
Frankfurt, Germany

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