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• W2040387972 abstract "Authors' reply Sir—The statistical modelling we used shows an overall reduction in sensitivity to mammographic screening for women on HRT; once the data are stratified into different age categories, statistical power is reduced. The point estimates provide an indication of the magnitude of the effects in the different age groups. Only in the 50–59 years and 60–69 years categories were there clinically significant reductions in the sensitivity of mammography with HRT use (7·6% and 20·4%, respectively). The 50–59 years and 60–69 years age groups were combined because they are the target group for mammographic screening in Australia. For that combined age group, there was a 15% reduction in the sensitivity of mammography with HRT use over a 2-year interval. Our statement about the 10% reduction in the sensitivity of mammography over a 1-year screening interval refers to women aged 50–69 years and the logistic regression analysis included all age groups. Among women aged 50–69 years at screening who had cancer diagnosed during a 1-year interval, the women on HRT were more likely to have a false negative than non-users of HRT (adjusted odds ratio 2·65 [1·34–5·21]). In the entire age group, the 95% CIs for the adjusted odds ratio of 1·72 are 0·98 to 3·03. Although these limits include the null value of one, and hence do not attain significance at the 5% level, it would be wrong to conclude that this indicates a lack of effect. Rather than acting as de-facto significance tests, CIs provide information about the size and precision of estimates.1Rothman K Greenland S Modern epidemiology. 2nd edn. Lippincott and Raven Publishers, Philadelphia1998Google Scholar The important point in this instance is that the magnitude of the effect over the 1-year interval is similar to that found in the 2-year interval and is consistent with the findings of other studies.2Seradour B Esteve J Heid P Jacquemier J Hormone replacement therapy and screening mammography: analysis of the results of the du Rhone programme.J Med Screening. 1999; 6: 99-102Crossref PubMed Scopus (63) Google Scholar, 3Rosenberg R Hunt W Williamson M et al.Effects of age, breast density, ethnicity, and estrogen replacement therapy on the sensitivity and cancer stage at diagnosis: review of 183 134 screening mammograms in Albuquerque, New Mexico.Radiology. 1998; 209: 511-518Crossref PubMed Scopus (348) Google Scholar Catherine Hayes and colleagues ask us why we did not find a significant reduction in the small cancer detection rate in HRT users The small cancer detection is dependent on at least two parameters: the sensitivity of mammography, and the underlying rate of invasive breast cancer in the population group. While we found that sensitivity was reduced in HRT users, which would decrease the small cancer detection rate, these women could also have a higher risk of breast cancer,4Collaborative Group on Hormonal Factors and Breast CancerBreast cancer and hormone replacement therapy: collaborative reanalysis from 51 epidemiological studies of 52 705 women with breast cancer and 108 411 women without breast cancer.Lancet. 1997; 350: 1047-1059Summary Full Text Full Text PDF PubMed Scopus (2460) Google Scholar which would have the opposite effect. Hormone replacement therapy and mammographyAnne Kavanagh and colleagues (Jan 22, p 270)1 reported on the accuracy of mammographic screening in women taking hormone replacement therapy (HRT). While we agree with their general conclusions certain questions remain insufficiently addressed by the investigators. Full-Text PDF" @default.
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• W2040387972 title "Hormone replacement therapy and mammography" @default.
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