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Why breast cancer figures don't show whole HRT picture

It is good news prescribing rates for HRT have dropped since the premature termination of the Women's Health Initiative Study (WHI) in July 2002. However, your Answer Back experts Narenda Pisal and Theresa Freeman-Wang (November 3) only quote the breast cancer risk for oestrogen-alone HRT in the Million Women Study.

The fact that the risk with combination HRT is nearly four times greater has caused much concern. The excess incidencefor combination HRT were six and 19 per 1,000 women for five and 10 years' use. The comparable figures in the WHI trial for five and seven years of use was six and 18.

In the first year of the WHI study twice as many combined HRT users had abnormal mammograms as placebo takers. Thequoted background incidence ofbreast cancer of 30 per 10,000 women general population must include breast cancers caused by previous use of combined progestogens and oestrogens given as oral contraceptives or HRT.

The reality is breast cancer incidences in hormone-taking countries have kept pace with the rises, falls and huge increases in hormone use for more than 40 years.

Dr Ellen Grant

Kingston-upon-Thames,Surrey

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