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To the Editor: The Women's Health Initiative Steering Committee¹ states that its findings on the relationship between breast cancer and use of estrogen-only hormone therapy are contrary to the preponderance of observational study results, including those from the recent Million Women Study. However, no consideration was given to the variation in the prevalence of obesity across study populations, and obese women have considerably lower relative risks than thinner women for hormone therapy–related breast cancer.^2-3

The relative risk of breast cancer associated with use of estrogen-only hormone therapy in the Million Women Study declined with increasing BMI, in line with the findings from other studies.² Since obesity was substantially more common in partipants in the Women's Health Initiative trial than in the UK-based Million Women Study (45% vs 18%, respectively, had a BMI >30), it seems inappropriate to directly compare the relative risks of breast cancer associated with use of estrogen . . . [Full Text of this Article]

Valerie Beral, FRCP
pa.valerie.beral@cancer.org.uk

Emily Banks; Gillian Reeves, MSc, PhD
Cancer Research UK Epidemiology Unit
Radcliffe Infirmary
Oxford, England
For the Million Women Study Collaborators

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