To the Editors: When citing the improved prognosis for breast cancer among estrogen-treated women, Barrett-Connor (1) offers the plausible explanation that their cancers were diagnosed earlier, presumably due to increased surveillance. I offer another plausible explanation: The increased incidence of breast cancer among estrogen-treated women is falsely inflated by overdiagnosis. The increased rate of breast cancer (and absence of an increased death rate) among these women may be caused by the more frequent diagnosis of noninvasive lesions, 75% of which would not have progressed to malignant disease if left untreated (2).
Women who use estrogen have a higher rate of
Napoli M. Postmenopausal Estrogen and Prevention Bias. Ann Intern Med. 1992;116:268. doi: 10.7326/0003-4819-116-3-268_1
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Published: Ann Intern Med. 1992;116(3):268.
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