Steroid hormone levels during pregnancy and incidence of maternal breast cancer.
Steroid hormone levels during pregnancy and incidence of maternal breast cancer.
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发表时间：
2002-04
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通讯作者：
J. Peck;B. Hulka;C. Poole;D. Savitz;D. Baird;B. E. Richardson
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作者：
J. Peck;B. Hulka;C. Poole;D. Savitz;D. Baird;B. E. Richardson
以前评估妊娠激素水平和母体乳腺癌的研究仅限于暴露的替代指标。这项研究直接评估了怀孕期间测量的血清类固醇激素水平与母亲患乳腺癌风险之间的关系。我们进行了一项巢式病例对照研究，以检查1959年至1966年期间怀孕妇女的妊娠晚期血清总未结合雌二醇、雌酮、雌三醇和孕酮水平。1969年至1991年，194例患者被诊断为原位或浸润性乳腺癌。对照组（n = 374）与指数妊娠时的年龄相匹配，采用随机招募。与低于最低十分位数的人群相比，孕酮水平升高与乳腺癌发病率降低相关[孕酮≥ 270 ng/ml的比值比（OR）为0.49; 95%可信区间（CI）为0.22-1.1]。在50岁或之前诊断的癌症中，这种关联更强（孕酮≥ 270 ng/ml的OR为0.3; 95% CI为0.1-0.9）。雌酮水平升高与总体发病率升高相关（雌酮≥ 18.7 ng/ml的OR为2.5; 95%CI为1.0-6.2），而未观察到与雌二醇呈正相关。太少的情况下发生在15年内的指数怀孕充分比较短期和长期的影响怀孕激素暴露。当评估雌激素与孕激素的比例时，有迹象表明，相对于孕激素，总雌激素和雌酮水平高的人乳腺癌的发病率适度增加。这些发现表明，怀孕类固醇激素水平是乳腺癌的危险因素。
Previous studies evaluating pregnancy hormone levels and maternal breast cancer were limited to surrogate indicators of exposure. This study directly evaluates the association between measured serum steroid hormone levels during pregnancy and maternal risk of breast cancer. A nested case-control study was conducted to examine third-trimester serum levels of total unconjugated estradiol, estrone, estriol, and progesterone in women who were pregnant between 1959 and 1966. Cases (n = 194) were diagnosed with in situ or invasive breast cancer between 1969 and 1991. Controls (n = 374) were matched to cases by age at the time of index pregnancy, using randomized recruitment. Elevated progesterone levels were associated with a decreased incidence of breast cancer [odds ratio (OR) for progesterone > or =270 ng/ml, 0.49; 95% confidence interval (CI), 0.22-1.1] relative to those below the lowest decile. This association was stronger for cancers diagnosed at or before age 50 (OR for progesterone > or =270 ng/ml, 0.3; 95% CI, 0.1-0.9). Increased estrone levels were associated with an increased incidence overall (OR for estrone > or =18.7 ng/ml, 2.5; 95% CI, 1.0-6.2), whereas a positive association with estradiol was not observed. Too few cases occurred within 15 years of the index pregnancy to compare adequately the short- and long-term effects of pregnancy hormone exposure. When estrogen-to-progesterone ratios were evaluated, there was an indication of a modest increased incidence of breast cancer for those with high total estrogens and high estrone levels relative to progesterone. These findings suggest that pregnancy steroid hormone levels are risk factors for breast cancer.