Hormone replacement therapy and risk of breast cancer with a favorable histology - Results of the Iowa Women's Health Study
Hormone replacement therapy and risk of breast cancer with a favorable histology - Results of the Iowa Women's Health Study
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DOI：
10.1001/jama.281.22.2091
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发表时间：
1999-06-09
影响因子：
120.7
通讯作者：
Sellers, TA
中科院分区：
文献类型：
--
作者：
Gapstur, SM;Morrow, M;Sellers, TA
上下文。绝经后长期使用激素替代疗法（HRT）似乎会增加患乳腺癌的风险。不同组织学类型的浸润性癌，使用激素替代疗法对乳腺癌风险的影响是否不同尚不清楚。目的：确定HRT使用与导管原位癌（DCIS）、组织学有利的浸润性癌、浸润性导管癌或小叶癌风险之间的关系。前瞻性队列研究，其参与者从1986年1月至1996年12月连续随访11年。设置和参与者。爱荷华州妇女健康研究，以人群为基础的随机样本，年龄在55至69岁之间的绝经后妇女。在37105名高危妇女队列中，总共发生了1520例乳腺癌病例。主要结果测量。肿瘤特异性乳腺癌的多变量调整相对危险度（RR）与曾经、当前或过去使用激素替代疗法的持续时间相关。HRT使用的持续时间与组织学良好的浸润性癌的风险相关，使用HRT 5年或更短时间的患者的RR为1.81(95%可信区间[Cl]， 1.07-3.07)，而使用HRT 5年以上的患者（趋势P = 0.005）在调整年龄和其他乳腺癌危险因素后的RR为2.65 （95% CI, 1.34-5.23）。HRT的使用与DCIS或浸润性导管癌或小叶癌的发生率之间没有关联。在目前的激素使用者中，在调整年龄和其他乳腺癌危险因素后，组织学良好的浸润性癌在使用5年及以下和使用5年以上的RRs （95% Cls）分别为4.42（2.00-9.76）和2.63（1.18-5.89）。浸润性导管癌或小叶癌的风险与目前使用HRT（少于或等于5年）相关，RR为1.38 （95% Cl, 1.03-1.85）。接受HRT治疗与预后良好的浸润性乳腺癌风险增加密切相关。这些数据为评估HRT使用的风险和益处增加了重要的临床信息。
Context. Long-term, postmenopausal use of hormone replacement therapy (HRT) appears to increase breast cancer risk. Whether the effect of HRT use on risk of breast cancer varies among histological types of invasive carcinoma is unknown.Objective. To determine associations between HRT use and risk of ductal carcinoma in situ (DCIS), invasive carcinoma with favorable histology, and invasive ductal or lobular carcinoma.Design. Prospective cohort study whose participants were followed up continuously for 11 years from January 1986 to December 1996.Setting and Participants. Iowa Women's Health Study, a population-based random sample of postmenopausal women aged 55 to 69 years in 1986. A total of 1520 incident breast cancer cases occurred in the at-risk cohort of 37105 women.Main outcome Measures. Multivariate-adjusted relative risk (RR) of tumor-specific breast cancers associated with duration of ever, current, or past HRT use.Results. Duration of ever HRT use was associated with risk of invasive carcinoma with a favorable histology, with an RR of 1.81 (95% confidence interval [Cl], 1.07-3.07) for those who used HRT 5 or fewer years vs an RR of 2.65 (95% CI, 1.34-5.23) for those who used HRT for more than 5 years (P for trend = .005) after adjustment for age and other breast cancer risk factors. There was no association between ever HRT use and the incidence of DCIS or invasive ductal or lobular carcinoma. Among current hormone users, after adjusting for age and other breast cancer risk factors, the RRs (95% Cls) of invasive carcinoma with a favorable histology were 4.42 (2.00-9.76) and 2.63 (1.18-5.89) for 5 or fewer years of use and for more than 5 years of use, respectively. Risk of invasive ductal or lobular carcinoma was associated with current use (less than or equal to 5 years) of HRT with an RR of 1.38 (95% Cl, 1.03-1.85).Conclusions. Exposure to HRT was associated most strongly with an increased risk of invasive breast cancer with a favorable prognosis. These data add important clinical information for assessing the risks and benefits of HRT use.