Cohort Profile: the Million Women Study
Cohort Profile: the Million Women Study
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DOI：
10.1093/ije/dyy065
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发表时间：
2019-02-01
影响因子：
7.7
通讯作者：
Young, Heather
中科院分区：
文献类型：
--
作者：
Green, Jane;Reeves, Gillian K.;Young, Heather
百万女性研究于20多年前（1996年）开始招募参与者。最初的刺激是获得与使用不同类型的绝经期激素治疗（HT）相关的乳腺癌风险的可靠前瞻性信息。在规划必要的大规模前瞻性研究时，一个同样重要的目标是获得可靠的信息，了解随着年龄的增长影响妇女健康的其他可能改变的因素的影响。20世纪90年代初，HT的使用在英国和其他地方迅速增加，部分原因是声称使用HT可以改善总体福祉并延长预期寿命。然而，到了20世纪90年代中期，全世界的证据开始表明HT制剂增加了乳腺癌的风险，尽管关于欧洲最常用的HT类型（含有雌激素和孕激素）的影响的信息很少。1同样明显的是，1940年代出生、1960年代成年的妇女的生活方式与前几代人有很大不同。例如，很大一部分人在青少年和青年时期就开始吸烟和使用口服避孕药，而这些行为的长期影响直到1990年代才得到可靠的研究。与此同时，越来越多的人关注肥胖的影响，并声称其他因素如饮食对健康有重要影响，所有这些都需要大规模的前瞻性证据，英国国家卫生服务（NHS）提供了非常有效的方法来建立和保持长期随访的大型前瞻性流行病学研究。超过99%的英国人口和所有百万女性研究参与者都在NHS注册，每个人都有一个独特的NHS号码。利用每个人的国民保健服务号码与定期收集的国民保健服务数据库建立电子联系，提供关于死亡、移民、癌症登记和住院的几乎完整的后续信息。全国保健服务乳房检查方案邀请所有在全国保健服务登记的特定年龄的联合王国妇女每三年进行一次免费的例行乳房检查。1996-2001年，该方案定期邀请50-64岁的妇女进行乳房X线检查，给每个人发一封信，告知她们在特定检查中心的具体日期和时间。在66个国民保健服务筛查中心，百万妇女研究招募问卷包括在筛查邀请函中。1994- 1996年的试点研究表明，在邀请函中列入一份问卷并不影响接受乳房检查。2百万妇女研究协调中心设在牛津大学纳菲尔德人口保健系癌症流行病学股。
The Million Women Study started recruiting participants over 20years ago, in 1996. The initial stimulus was to obtain robust prospective information on the risk of breast cancer associated with use of different types of menopausal hormone therapy (HT). When planning the necessary largescale prospective study, an equally important aim was to obtain reliable information on the effects of other potentially modifiable factors that affect women’s health as they age. In the early 1990s use of HT increased rapidly in the UK and elsewhere, stimulated in part by claims that use of HT could improve general well-being and increase life expectancy. By the mid-1990s, however, worldwide evidence was beginning to show that HT preparations increased breast cancer risk, though there was little information about the effect of the type of HT most commonly used in Europe, containing both oestrogens and progestagens. 1 It was also clear that women born in the 1940s, who reached adulthood in the 1960s, had considerably different lifestyles compared with previous generations. For example, large proportions had begun smoking and using oral contraceptives as teenagers and young adults, and the long-term effects of these behaviours could not be studied reliably until the 1990s. At the same time there was growing concern about the effects of the increasing prevalence of obesity, and claims that other factors such as diet had important effects on health, all of which required largescale prospective evidence.The UK National Health Service (NHS) provides extraordinarily efficient ways of establishing and maintaining long-term follow-up for large prospective epidemiological studies. Over 99% of the UK population, and all Million Women Study participants, are registered with the NHS, and every individual has a unique NHS number. Electronic linkage, using each individual’s NHS number, to routinely collected NHS databases provides virtually complete follow-up information about deaths, emigrations, cancer registrations and hospital admissions. The NHS Breast Screening Programme invites all UK women registered with the NHS, of a specified age, for free routine breast screening every 3 years. In 1996–2001 the programme routinely invited women aged 50–64 years for mammographic screening, by sending each individual a letter offering them a specific date and time at a specific screening centre. In 66 NHS screening centres, the Million Women Study recruitment questionnaire was included with the invitation letter for screening. Pilot studies in 1994–96 had shown that inclusion of a questionnaire with the invitation did not affect uptake of breast screening. 2 The coordinating centre for the Million Women Study is based in the Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford.