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Decrease in breast cancer incidence following a rapid fall in use of hormone replacement therapy in Australia

Karen Canfell, Emily Banks, Mark Clements, Yoon J Kang and Valerie Beral
Med J Aust 2009; 190 (3): . || doi: 10.5694/j.1326-5377.2009.tb02330.x
Published online: 2 February 2009

In reply: In saying that our work on the effect of hormone replacement therapy (HRT) on the development of breast cancer is “at best an hypothesis-generating exercise”, Giles and colleagues ignore both the preceding literature and the fact that our analysis of Australian data explicitly tested the hypothesis raised by an analysis of United States data. Both the US and Australian analyses showed falling breast cancer incidence from 2001 in women aged ≥ 50 years, but not in younger women, following large reductions in HRT use.1,2


  • 1 Cancer Epidemiology Research Unit, Cancer Council NSW, Sydney, NSW.
  • 2 School of Public Health, University of Sydney, Sydney, NSW.
  • 3 National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT.
  • 4 Cancer Epidemiology Unit, University of Oxford, Oxford, UK.


Correspondence: karenc@nswcc.org.au

  • 1. Ravdin PM, Cronin KA, Howlader N, et al. The decrease in breast-cancer incidence in 2003 in the United States. N Engl J Med 2007; 356: 1670-1674.
  • 2. Canfell K, Banks E, Moa AM, Beral V. Decrease in breast cancer incidence following a rapid fall in use of hormone replacement therapy in Australia. Med J Aust 2008; 188: 641-644.
  • 3. Peto R. Misleading subgroup analyses in GISSI. Am J Cardiol 1990; 66: 771-772.
  • 4. Gail M, Simon R. Testing for qualitative interactions between treatment effects and patient subsets. Biometrics 1985; 41: 361-372.
  • 5. Efron B, Morris C. Stein’s paradox in statistics. Sci Am 1977; 236: 119-127.
  • 6. Medicare Australia. Pharmaceutical Benefits Scheme Statistics. 2007. http://www.medicareaustralia.gov.au/providers/health_statistics/statistical_reporting/pbs.htm (accessed Dec 2007).
  • 7. Kumle M. Declining breast cancer incidence and decreased HRT use [editorial]. Lancet 2008; 372: 608-610.

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