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In Reply:
We thank Dr Balkees Abderrahman for the interest in our study. Based on in vitro data with cultured breast cancer (BC) cells, Dr Abderrahman logically proposes that NETA-containing combination therapy (EPT) could be safer for breasts than MPA-EPT. Our previous data do not support this hypothesis, since the incidence of BC was significantly higher (39% difference) in the users (>5 years) of NETA-EPT than MPA-EPT1 Perhaps, the impact of MPA or NETA on BC-risk in vivo depends also on the estrogen component, which is estradiol in Finland, but CEE in the Women's Health Initiative trial. There have been no drastic changes in the use of MPA or NETA-EPT in Finland during the past two decades, and bioidentical progestrone came into wider clinical use after the termination of our study.

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