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In 'What's new in breast cancer' (Clinical, February 12) surgeons Cunnick and Sacks say that the Million Women Study (MWS) is seriously flawed, but the results were similar to the Women's Health Initiative (WHI).

Both studies found increased risks of breast cancer in the first year of HRT ­ up to 63 per cent in the MWS and twice as many first-year abnormal mammograms in the WHI study1.

Both found three times more extra risks with longer than shorter use of combined HRT, and with oestrogens and transdermal hormones in the MWS. Progestogens caused four times more breast cancer than oestrogens. The oestrogen WHI study was terminated prematurely because of increased risk of strokes.

The Swedish HABITS (hormonal replacement therapy after breast cancer ­ is it safe?) trial was terminated after two years because 28 patients, mostly current HRT users, had new breast cancer events, compared with five non-users2.

As HRT increases breast cancer risks, why do experts advise breast cancer patients to try progestogens, topical oestrogens, or the synthetic steroid drug, tibolone, which has progestogenic, androgenic and oestrogenic activities? The MWS found a significant 45 per cent increased relative risk of incident invasive breast cancer in current users of tibolone.

Menopausal symptoms and depression can respond safely to low-allergy diets and repletion of nutrient deficiencies.

Dr Ellen Grant

Kingston-upon-Thames

Surrey

1 Chlebowski RT et al, for the WHI investigators. Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: The Women's Health Initiative randomised trial. JAMA 2003;289:3243-53

2 Holmberg L, Anderson H et al. HABITS steering and data monitoring committees. HABITS (hormonal replacement therapy after breast cancer ­ is it safe?), a randomised comparison: trial stopped. Lancet 2004; 363: 453-5

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