Hormones and breast cancer
Hormones and breast cancer
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DOI：
10.1093/humupd/dmh025
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发表时间：
2004-07-01
影响因子：
13.3
通讯作者：
Volpe, A
中科院分区：
文献类型：
--
作者：
Blamey, R;Collins, J;Volpe, A
妇女乳腺癌的发病率因年龄、乳腺肿块和内源性和外源性激素的暴露而异。年龄是唯一最重要的因素，如果如预计的那样，到2050年，32%的妇女将达到60岁以上，那么世界乳腺癌发病率将超过目前的每年10(6)例。影响乳腺生长的荷尔蒙会增加患乳腺癌的风险；比如月经初潮提前，更年期推迟。生育可以预防乳腺癌的后期发展，而母乳喂养可以进一步降低风险。随着母乳喂养总时间的增加，乳腺癌风险下降得更多。在对51项流行病学研究数据的综合再分析中，对激素避孕药的暴露进行了评估。口服避孕药使用者患乳腺癌的相对风险有短暂的小幅增加，但由于使用避孕药通常发生在乳腺癌相对罕见的年轻时期，这种增加对总体发病率几乎没有影响。相反，接受更年期激素治疗时，乳腺癌的基线风险较高，流行病学研究和随机对照试验一致发现，雌激素和孕激素联合使用会增加乳腺癌的风险。一级亲属中有乳腺癌家族史的女性患乳腺癌的风险增加，但没有证据表明这种风险因女性使用口服避孕药或更年期激素治疗而有所不同。选择性雌激素受体调节剂可用于治疗和/或预防乳腺癌，这取决于其对雌激素靶组织的特异性激动剂或拮抗剂作用。
The incidence of breast cancer in women varies with age, mammary gland mass and exposure to endogenous and exogenous hormones. Age is the single most important factor and if, as projected, 32% of women will be aged >60 years by 2050, world breast cancer incidence will exceed the current 10(6) per year. Hormonal influences that affect growth of the mammary gland increase the risk of breast cancer; for example earlier menarche and later menopause. Childbearing protects against later development of breast cancer, and breastfeeding further decreases the risk. The breast cancer risk declines more with increasing total duration of breastfeeding. Exposure to hormonal contraceptives has been evaluated in a combined reanalysis of data from 51 epidemiological studies. There is a small transient increase in the relative risk of breast cancer among users of oral contraceptives but, since use typically occurs at young ages when breast cancer is relatively rare, such an increase would have little effect on overall incidence rates. In contrast, exposure to menopause hormone treatment occurs when the baseline risk of breast cancer is higher, and epidemiological studies and randomized controlled trials consistently find an increase in breast cancer risk with exposure to combined estrogen and progestogen. Women with a family history of breast cancer in first degree relatives have an increased risk of breast cancer but there is no evidence to suggest that this differs according to a woman's use of oral contraceptives or menopause hormone treatment. Selective estrogen receptor modulators are useful in the treatment and/or prevention of breast cancer depending on the specific agonist or antagonist effects on estrogen target tissues.