Estrogen replacement therapy and risk of fatal breast cancer in a prospective cohort of postmenopausal women in the United States
Estrogen replacement therapy and risk of fatal breast cancer in a prospective cohort of postmenopausal women in the United States
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DOI：
10.1007/bf00052671
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发表时间：
1996-07-01
影响因子：
2.3
通讯作者：
Heath, CW
中科院分区：
文献类型：
--
作者：
Willis, DB;Calle, EE;Heath, CW
本研究在美国进行了一项大型前瞻性研究，探讨了致死性乳腺癌与使用雌激素替代疗法（ERT）之间的关系。经过9年的随访，在422,373名绝经后妇女中观察到1,469例乳腺癌死亡，这些妇女在研究开始时没有癌症，并提供了雌激素使用的信息。Cox比例风险模型的结果显示，经过11个其他潜在危险因素的调整，一直使用ERT与致命性乳腺癌的风险显著降低相关（比率比[RR] = 0.84, 95%置信区间[CI] = 0.75-0.94）。首次使用ERT的年龄越小，风险降低的趋势中等（P = 0.07）。这种风险降低在40岁前自然绝经的女性中最为明显（RR = 0.59, CI = 0.40-0.87）。基线时的雌激素使用者或前使用者没有明显的使用时间增加风险的趋势，前使用者自上次使用后的几年也没有任何趋势。ERT和乳腺癌死亡率之间的关系因月经初潮的年龄和自我报告的乳腺囊肿病史而异。雌激素使用状况（基线/前）、首次使用年龄、使用时间或自上次使用以来的年限均未观察到ERT致死性乳腺癌风险增加。这些发现表明，经常使用ERT与致命乳腺癌风险降低16%有关。
This study examines the relationship between fatal breast cancer and use of estrogen replacement therapy (ERT) among women in a large prospective study in the United States. After nine years of follow-up, 1,469 breast cancer deaths were observed in a cohort of 422,373 postmenopausal women who were cancer free at study entry and who supplied information on estrogen use Results from Cox proportional hazards modeling, adjusted for 11 other potential risk factors, showed that ever-use of ERT was associated with a significantly decreased risk of fatal breast cancer (rate ratio [RR] = 0.84, 95 percent confidence interval [CI] = 0.75-0.94). There was a moderate trend (P = 0.07) of decreasing risk with younger age at first use of ERT. This decreased risk was most pronounced in women who experienced natural menopause before the age of 40 years (RR = 0.59, CI = 0.40-0.87). There was no discernible trend of increasing risk with duration of use in estrogen users at baseline or former users, nor was there any trend in years since last use in former users. The relationship between ERT and breast cancer mortality differed by age at menarche and by a self-reported history of breast cysts. No increased risk of fatal breast cancer with ERT was observed with estrogen use status (baseline/former), age at first use, duration of use, or years since last use. These findings suggest that ever-use of ERT is associated with a 16 percent decreased risk of fatal breast cancer.