Estrogen plus progestin and breast cancer incidence and mortality in postmenopausal women.
Estrogen plus progestin and breast cancer incidence and mortality in postmenopausal women.
复制标题
雌激素加孕激素与绝经后妇女乳腺癌的发病率和死亡率。
DOI：
10.1001/jama.2010.1500
复制
发表时间：
2010-10-20
期刊：
影响因子：
--
通讯作者：
WHI Investigators
中科院分区：
文献类型：
--
作者：
Chlebowski RT;Anderson GL;Gass M;Lane DS;Aragaki AK;Kuller LH;Manson JE;Stefanick ML;Ockene J;Sarto GE;Johnson KC;Wactawski-Wende J;Ravdin PM;Schenken R;Hendrix SL;Rajkovic A;Rohan TE;Yasmeen S;Prentice RL;WHI Investigators
在女性健康倡议的雌激素加孕激素试验中，经过平均（标准差）5.6（1.3）年（范围3.7 - 8.6年）的干预以及平均7.9（1.4）年的随访，联合激素疗法使乳腺癌发病率增加。然而，乳腺癌死亡率的结果此前尚未报道。
为了确定在截至2009年8月14日总计平均11.0（2.7）年的随访后，雌激素加孕激素对累积乳腺癌发病率和死亡率的影响。
16608名年龄在50 - 79岁、未做过子宫切除术的绝经后女性被随机分配接受结合马雌激素（0.625毫克/天）加醋酸甲羟孕酮（2.5毫克/天）或安慰剂治疗。在原始试验完成日期（2005年3月31日）之后，继续随访乳腺癌发病率需要重新获得同意，83%的人获得了同意。
浸润性乳腺癌发病率和乳腺癌死亡率。
在意向性分析中，包括所有随机参与者，对2005年3月31日不同意进一步随访的人进行删失处理，与安慰剂相比，雌激素加孕激素增加了浸润性乳腺癌的发病率（病例数分别为385例[0.42%/年]对293例[0.34%/年]；风险比[HR]为1.25，95%置信区间[CI]为1.07 - 1.46；P = 0.004）。雌激素加孕激素组的乳腺癌在组织学和分级上相似，但更有可能出现淋巴结阳性（分别为81例[23.7%]对43例[16.2%]；P = 0.03）。雌激素加孕激素组直接归因于乳腺癌的死亡人数更多（死亡数分别为25例[0.03%/年]对12例[0.01%/年]；HR为1.96；95% CI为1.00 - 4.04，P = 0.049），乳腺癌诊断后所有原因导致的死亡人数也是如此（死亡数分别为51例[0.05%/年]对31例[0.03%/年]；HR为1.57，95% CI为1.01 - 2.48；P = 0.045）。
雌激素加孕激素会增加乳腺癌发病率，且癌症更常出现淋巴结阳性。联合使用雌激素加孕激素似乎也会增加乳腺癌死亡率。
In the Women's Health Initiative estrogen plus progestin trial, after mean (SD) intervention of 5.6 (1.3) years (range 3.7 to 8.6 years) and mean follow-up of 7.9 (1.4) years, breast cancer incidence was increased by combined hormone therapy. However, breast cancer mortality results have not been previously reported. To determine estrogen plus progestin effects on cumulative breast cancer incidence and mortality after a total mean follow-up of 11.0 (2.7) years thru August 14, 2009. 16,608 postmenopausal women, aged 50-79 years with no prior hysterectomy, were randomly assigned to combined conjugated equine estrogens (0.625 mg/d) plus medroxyprogesterone acetate (2.5 mg/d) or placebo. After the original trial completion date (March 31, 2005) re-consent was required for continued follow-up for breast cancer incidence and was obtained in 83%. Invasive breast cancer incidence and breast cancer mortality. In intent-to-treat analyses including all randomized participants, censoring those on March 31, 2005 not-consenting for additional follow-up, estrogen plus progestin increased invasive breast cancers compared with placebo (385 [0.42%/yr] vs 293 [0.34%/yr] cases; hazard ratio [HR] 1.25, 95% confidence interval (CI) 1.07-1.46; P=.004). The breast cancers in the estrogen plus progestin group were similar in histology and grade but were more likely to be node positive (81 [23.7%] vs 43 [16.2%], respectively; P=0.03). Deaths directly attributed to breast cancer were greater in the estrogen plus progestin group (25 [0.03%/yr] vs 12 [0.01%/yr] deaths; HR, 1.96; 95% CI 1.00-4.04, P=.049) as were deaths from all causes occurring after a breast cancer diagnosis (51 [0.05%/yr] vs 31 [0.03%/yr] deaths; HR 1.57, 95% CI 1.01-2.48; P=.045). Estrogen plus progestin increases breast cancer incidence with cancers more commonly node positive. Breast cancer mortality also appears to be increased with combined estrogen plus progestin use.
登录
查看更多内容
影响因子：
45.3
作者：
Pinder, Mary C.;Duan, Zhigang;Giordano, Sharon H.
通讯作者：
Giordano, Sharon H.
影响因子：
5.6
作者：
Anderson, GL;Manson, J;Prentice, RL
通讯作者：
Prentice, RL
影响因子：
--
作者：
Chlebowski, Rowan T.;Anderson, Garnet;McTiernan, Anne
通讯作者：
McTiernan, Anne
影响因子：
6.2
作者：
Chen, WY;Hankinson, SE;Colditz, GA
通讯作者：
Colditz, GA
影响因子：
120.7
作者：
Chlebowski, RT;Hendrix, SL;McTiernan, A
通讯作者：
McTiernan, A