HORMONE REPLACEMENT THERAPY AND BREAST-CANCER MORTALITY IN SWEDISH WOMEN - RESULTS AFTER ADJUSTMENT FOR HEALTHY DRUG-USER EFFECT
HORMONE REPLACEMENT THERAPY AND BREAST-CANCER MORTALITY IN SWEDISH WOMEN - RESULTS AFTER ADJUSTMENT FOR HEALTHY DRUG-USER EFFECT
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DOI：
10.1007/bf00051340
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发表时间：
1993-07-01
影响因子：
2.3
通讯作者：
ADAMI, HO
中科院分区：
文献类型：
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作者：
YUEN, J;PERSSON, I;ADAMI, HO
长期激素替代治疗后乳腺癌死亡率无变化。对于发病率和死亡率之间的明显差异，一个可以想象的解释可能是由于接受替代激素的妇女与未接触激素的妇女相比乳腺癌患病率较低而产生的选择偏倚。我们使用了一种新的方法来纠正由于这种“健康的药物使用者效应”而产生的偏倚，方法是调整我们队列招募期间普遍存在的此类病例的外部、基于人群的死亡率。在这一队列中，约有23，000名瑞典妇女接受了各种激素替代方案，在随访12年后分析了乳腺癌死亡率。外部分析显示，调整程序后，乳腺癌的总体标准化死亡率从0.71上升到0.81，但与统一没有显著差异。在多变量回归模型中，排除队列中的流行病例，女性处方雌二醇，结合雌激素，或雌激素-炔雌醇组合相对于其他和弱雌激素的风险并不高，相对风险分别为0.81和0.68。根据目前的分析方法，我们得出结论，乳腺癌死亡率似乎没有改变整体或亚组，尽管发病率增加。
No change of breast cancer mortality has been reported previously after long-term hormone replacement therapy. A conceivable explanation for the apparent discrepancy between incidence and mortality may be selection bias due to lower prevalence of breast cancer in women who receive replacement hormones, compared with nonexposed women. We used a new approach to correct for bias due to this 'healthy drug-user effect,' by adjusting the external, population-based, mortality rates for such cases prevalent during the recruitment period of our cohort. In this cohort of some 23,000 Swedish women, who were prescribed various hormone replacement regimens, breast cancer mortality was analyzed after follow-up to 12 years. External analyses revealed overall standardized mortality ratios for breast cancer rising from 0.71 to 0.81, but not significantly different from unity, after adjustment procedures. In multivariate regression models, excluding prevalent cases in the cohort, women prescribed estradiol, conjugated estrogens, or an estrogen-progestin combination were not at a higher risk relative to those given other and weak estrogens, relative risks being 0.81 and 0.68, respectively. On the basis of the present analytical approach, we conclude that breast cancer mortality does not appear to be changed overall or in subgroups, despite increased incidence.