Sex hormones, risk factors, and risk of estrogen receptor-positive breast cancer in older women: A long-term prospective study
Sex hormones, risk factors, and risk of estrogen receptor-positive breast cancer in older women: A long-term prospective study
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DOI：
10.1158/1055-9965.epi-04-0375
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发表时间：
2005-05-01
影响因子：
3.8
通讯作者：
Cauleys, JA
中科院分区：
文献类型：
--
作者：
Cummings, SR;Lee, JS;Cauleys, JA
目的：抗雌激素可降低雌激素受体阳性(ER+)乳腺癌的风险，但不能降低ER阴性(ER-)乳腺癌的风险。ER+癌症高危女性将最有可能从这些治疗中受益，但预测ER+癌症的最好方法尚不确定。方法：我们前瞻性地评估了乳腺癌的假定危险因素和-190摄氏度的存档血清，该队列来自社区队列，年龄=65岁，没有乳腺癌病史。乳腺癌的随访时间超过10.5年，成功率为99%。采用病例队列设计，我们测量了196例浸润性ER+癌症患者和378名随机选择的对照组的雌二醇和睾酮的基线水平。结果：睾酮水平在最高二分之一的女性患ER+乳腺癌的风险增加了4倍(P<；0.0001)。高雌二醇浓度也表明风险增加，但在调整睾酮后并不是一个显着的预测因素。受过16年教育的女性患ER+癌症的风险增加了2.1倍(P=0.03)，但没有其他危险因素与ER+癌症的风险增加显著相关。有乳腺癌家族史的女性患ER癌的风险增加了2.9倍(P=0.002)，而ER+癌的风险没有增加(相对危险度分别为1.2，0.8~1.8)。如果得到证实，在识别最有可能从抗雌激素化学预防中受益的老年女性方面，高睾酮水平可能比乳腺癌家族史和其他传统风险因素更准确。
Objective: Antiestrogens reduce the risk of estrogen receptor-positive (ER+) but not ER-negative (ER-) breast cancer. Women at high risk of ER+ cancer would be the most likely to benefit from these treatments, but the best approach to predicting ER+ cancer is uncertain.Methods: We prospectively assessed putative risk factors for breast cancer and archived serum at -190 degrees C from a community-based cohort of 7,676 women ages >= 65 years who had no history of breast cancer. Follow-up for breast cancer over 10.5 years was 99% complete. Using a case-cohort design, we measured baseline levels of estradiol and testosterone in 196 cases of invasive ER+ cancer and 378 randomly selected controls.Results: Women whose testosterone level in highest two quintiles had a 4-fold increased risk of ER+ breast cancer (P < 0.0001). High estradiol concentration also indicated an increased risk but was not a significant predictor after adjustment for testosterone. Women with > 16 years of education had a 2.1 times increased risk (P = 0.03) of ER+ cancer, but no other risk factors were significantly related to an increased risk of ER+ cancer. Women with a family history of breast cancer had a 2.9-fold increased risk of ER- cancer (P = 0.002) but no increased risk of ER+ cancer (relative hazard = 1.2, 0.8-1.8).Conclusions: High serum testosterone and advanced education predicted ER+ breast cancer. If confirmed, high testosterone level may be more accurate than family history of breast cancer and other conventional risk factors for identifying older women who are most likely to benefit from antiestrogen chemoprevention.