Effect of hormone replacement therapy on breast cancer risk: estrogen versus estrogen plus progestin.
Effect of hormone replacement therapy on breast cancer risk: estrogen versus estrogen plus progestin.
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DOI：
10.1097/00006254-200007000-00022
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发表时间：
2000-02
期刊：
影响因子：
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通讯作者：
R. Ross;A. Paganini-Hill;Peggy Wan;M. Pike
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文献类型：
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作者：
R. Ross;A. Paganini-Hill;Peggy Wan;M. Pike
激素替代疗法（HRT）作为无对抗雌激素替代疗法（ERT）在20世纪60年代和70年代在美国广泛流行。最近的处方实践倾向于联合HRT (CHRT)，即在整个月经周期（连续联合替代疗法[CCRT]）或月经周期的一部分（序贯雌激素加黄体酮治疗[SEPRT]）中添加黄体酮。很少有数据表明CHRT与乳腺癌风险之间存在关联。我们在一项基于人群的病例对照研究中确定了CHRT对女性患乳腺癌风险的影响。方法病例研究对象包括20世纪80年代末和90年代在加州洛杉矶县确诊超过4（1/2）年的乳腺癌患者。对照对象是社区居民，他们在年龄和种族上与病例对象相匹配。对病例和对照组进行面谈，以收集有关已知乳腺癌危险因素和激素替代疗法使用情况的信息。对1897例绝经后病例和1637例55-72岁未行单纯子宫切除术的绝经后对照进行了分析。在同时调整不同形式的HRT和已知的乳腺癌危险因素后，以比值比（ORs）估计与各种类型HRT相关的乳腺癌风险。所有P值都是双面的。结果：HRT每使用5年，乳腺癌风险增加10% (OR(5) = 1.10；95%置信区间[CI] = 1.02-1.18)。使用CHRT的风险明显更高(OR(5) = 1.24；95% CI = 1.07-1.45)比ERT (OR(5) = 1。06;95% ci = 0.97-1.15)。SEPRT的风险估计更高(OR(5) = 1.38；95% CI = 1.13-1.68)比CCRT (OR(5) = 1.09；95% ci = 0。88-1.35)，但差异无统计学意义。结论：本研究提供了强有力的证据，表明与单独使用雌激素相比，在HRT中添加黄体酮可显著提高乳腺癌的风险。这些发现对使用HRT的妇女进行HRT的风险-收益方程具有重要意义。
BACKGROUND Hormone replacement therapy (HRT) given as unopposed estrogen replacement therapy (ERT) gained widespread popularity in the United States in the 1960s and 1970s. Recent prescribing practices have favored combination HRT (CHRT), i.e., adding a progestin to estrogen for the entire monthly cycle (continuous combined replacement therapy [CCRT]) or a part of the cycle (sequential estrogen plus progestin therapy [SEPRT]). Few data exist on the association between CHRT and breast cancer risk. We determined the effects of CHRT on a woman's risk of developing breast cancer in a population-based, case-control study. METHODS Case subjects included those with incident breast cancers diagnosed over 4(1/2) years in Los Angeles County, CA, in the late 1980s and 1990s. Control subjects were neighborhood residents who were individually matched to case subjects on age and race. Case subjects and control subjects were interviewed in person to collect information on known breast cancer risk factors as well as on HRT use. Information on 1897 postmenopausal case subjects and on 1637 postmenopausal control subjects aged 55-72 years who had not undergone a simple hysterectomy was analyzed. Breast cancer risks associated with the various types of HRT were estimated as odds ratios (ORs) after adjusting simultaneously for the different forms of HRT and for known risk factors of breast cancer. All P values are two-sided. RESULTS HRT was associated with a 10% higher breast cancer risk for each 5 years of use (OR(5) = 1.10; 95% confidence interval [CI] = 1.02-1.18). Risk was substantially higher for CHRT use (OR(5) = 1.24; 95% CI = 1.07-1.45) than for ERT use (OR(5) = 1. 06; 95% CI = 0.97-1.15). Risk estimates were higher for SEPRT (OR(5) = 1.38; 95% CI = 1.13-1.68) than for CCRT (OR(5) = 1.09; 95% CI = 0. 88-1.35), but this difference was not statistically significant. CONCLUSIONS This study provides strong evidence that the addition of a progestin to HRT enhances markedly the risk of breast cancer relative to estrogen use alone. These findings have important implications for the risk-benefit equation for HRT in women using CHRT.