The Postmenopausal Estrogen/Breast Cancer Controversy

Abstract

To the Editor. —As Dr Henrich 1 persuasively points out, there remains no compelling evidence that use of postmenopausal estrogen replacement therapy (ERT) places women at increased risk for the development of breast cancer. While criteria for the rational administration of estrogen are being defined for the general population of postmenopausal women who may benefit from ERT during the latter decades of their lives, guidelines do not exist for the growing number of women who have had the diagnosis of breast cancer at some point before the development of menopause. Postmenopausal estrogen deficiency places all women, including those who have been treated for breast cancer, at increased risk for osteoporosis and heart disease. However, because of theoretical concerns that estrogen may adversely affect the course of breast cancer, ERT has not been considered appropriate for this latter group of patients. 2 Thus, an ever-increasing number of young, postmenopausal women with