Estrogen Therapy and Endometrial Carcinoma

To the Editor.—  Dr Khandekar and his colleagues, in the Archives (138:539-541, 1978), have reemphasized one of the potential complications of highdose exogenous estrogen administration in women, namely, the development of endometrial carcinoma. As indicated in their article, the patients received therapeutic doses of estrogenic hormones for metastatic mammary carcinoma. The authors correctly emphasized that this potential risk should not constrain one from the use of this highly effective medication in such serious circumstances.One aspect of these cases warrants comment. I have seen a number of patients with vaginal bleeding after treatment of breast carcinoma, whose endometrial or cervical biopsy specimens showed metastatic mammary carcinoma. It is not clear whether the authors considered this possibility. This is of particular importance, because the evidence presented for endometrial carcinoma is not equally strong for all of their cases. No illustration was provided for case 1, in which carcinoma was seen only