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To the Editor: In contrast to their current report, the WHI investigators¹ previously reported that the use of estrogen-plus-progestin increased the risk of breast cancer.² More than 40% of women who received unopposed estrogen had had their ovaries removed. The ovaries continue to produce hormones well after menopause, albeit at lower levels.³ Supplemental estrogen after oophorectomy may be beneficial in that it helps replace physiological levels, whereas extra estrogen given to women who already have physiologically normal levels of estrogen, given their age, is additive and may be harmful. Thus, the authors should have analyzed these 2 groups separately.

Vicki F. Meyer, PhD
vmeyer@banshee.sar.usf.edu
University of South Florida-Sarasota

1. The Women's Health Initiative Steering Committee. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial. JAMA. 2004;291:1701-1712. FREE FULL TEXT 2. Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen-plus-progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA. 2002;288:321-333. FREE FULL TEXT 3. Garcia CR, Cutler WB. Preservation of the ovary: a reevaluation. Fertil Steril. 1984;42:510-514. PUBMED

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292:683-684.

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