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William D. Dupont, PhD
Vanderbilt University School of Medicine Nashville, Tenn

JAMA. 1991;265(14):1824.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor. —

Colditz et al¹ have made a significant contribution to our knowledge of the relationship between estrogen replacement therapy and breast cancer. I do not, however, share the authors' confidence that their results were unaffected by bias due to increased surveillance of estrogen users. Among never users, the crude incidence of breast cancer was 354 cases in 186 466 women, or 190 per 100 000 women per year (see Table 2 of Colditz et al). If current users had also had this incidence, the authors would have observed 144 breast cancers during 75 643 person-years of follow-up in the current user group. In fact, they observed 180 cases, 36 more than expected. It is plausible that these 36 excess cancers might be due to increased surveillance for breast cancer. In late 1974, publicity surrounded the diagnosis of breast cancer in the wives of the president and . . . [Full Text PDF of this Article]

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