A PROSPECTIVE-STUDY OF ENDOGENOUS ESTROGENS AND BREAST-CANCER IN POSTMENOPAUSAL WOMEN
A PROSPECTIVE-STUDY OF ENDOGENOUS ESTROGENS AND BREAST-CANCER IN POSTMENOPAUSAL WOMEN
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DOI：
10.1093/jnci/87.3.190
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发表时间：
1995-02-01
影响因子：
10.3
通讯作者：
PASTERNACK, BS
中科院分区：
文献类型：
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作者：
TONIOLO, PG;LEVITZ, M;PASTERNACK, BS
背景：间接证据表明内源性雌激素与女性乳腺癌风险增加有关，但直接的流行病学支持有限。特别是，只有少数小型前瞻性研究解决了这个问题。目的：我们的目的是评估两种主要内源性雌激素——雌酮和雌二醇——在临床发病前的循环水平与乳腺癌风险的关系。方法：在一项前瞻性队列研究中，对14291名纽约市妇女进行了血清雌激素水平与乳腺癌风险之间的关系进行了研究，这些妇女年龄在35-65岁之间，在抽血时接受了乳腺癌筛查，并且没有被诊断患有乳腺癌。在前5年半的研究中，我们在绝经后组中发现了130例乳腺癌（7063名妇女，35 509人年）。病例受试者和两倍的绝经后对照受试者被纳入嵌套在队列中的病例对照研究。生化分析游离雌二醇百分比、雌二醇与性激素结合球蛋白（SHBG）结合百分比、总雌二醇、雌酮和促卵泡激素对采样后保存在-80℃的血清进行。结果：随着总雌二醇四分位数的增加，乳腺癌的优势比（or）（以体重（kg）除以身高(m)的平方）分别为1.0、0.9、1.8和1.8 (P值为趋势值= 0.06)；雌酮升高四分位数的or值分别为1.0、2.2、3.7、2.5（趋势P值= 0.06）。对于游离雌二醇（定义为不与蛋白质结合的雌二醇的比例）增加的四分位数，经queelet指数调整的乳腺癌的or分别为1.0、1.4、3.0和2.9（趋势P值）
Background: Circumstantial evidence links endogenous estrogens to increased risk of breast cancer in women, but direct epidemiologic support is limited. In particular, only a few small prospective studies have addressed this issue. Purpose: Our purpose was fo assess breast cancer risk in relation to circulating levels of the two major endogenous estrogens, estrone and estradiol, measured before the clinical onset of the disease. Methods: The association between serum levels of estrogens and the risk of breast cancer was examined in a prospective cohort study of 14 291 New York City women, 35-65 years of age, who received screening for breast cancer at the time of blood sampling and who had not been diagnosed with breast cancer. During the first 5 1/2 years of study, we identified 130 breast cancers among the postmenopausal group (7063 women, 35 509 person-years). The case subjects and twice as many postmenopausal control subjects were included in a case-control study nested within the cohort. Biochemical analyses for percent free estradiol, percent estradiol bound to sex hormone-binding globulin (SHBG), total estradiol, estrone, and follicle-stimulating hormone were performed on sera that had been kept at -80 degrees C since sampling. Results: For increasing quartiles of total estradiol, the odds ratio (ORs) of breast cancer, as adjusted for Quetelet index (weight in kilograms divided by the square of the height in meters), were 1.0, 0.9, 1.8, and 1.8 (P value for trend = .06); the ORs for increasing quartiles of estrone were 1.0, 2.2, 3.7, and 2.5 (P value for trend = .06). For increasing quartiles of free estradiol, defined as the fraction of estradiol that is not bound to proteins, the Quetelet index-adjusted ORs of breast cancer were 1.0, 1.4, 3.0, and 2.9 (P value for trend