Hormone replacement therapy containing progestins and given continuously increases breast carcinoma risk in Sweden
Hormone replacement therapy containing progestins and given continuously increases breast carcinoma risk in Sweden
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DOI：
10.1002/cncr.11205
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发表时间：
2003-03-15
期刊：
影响因子：
6.2
通讯作者：
Bladström, A
中科院分区：
文献类型：
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作者：
Olsson, HL;Ingvar, C;Bladström, A
背景。作者先前报道了使用激素替代疗法（HRT）的时间越长，患乳腺癌的风险越高。目前尚不清楚不同类型的激素替代疗法是否会带来不同的风险。在这项研究中，在1990-1992年期间对29,508名妇女进行了以人群为基础的队列访谈，以确定不同类型和使用HRT的时间是否存在乳腺癌风险的差异。在2001年12月随访期结束时，队列人数达到298,649人/年。乳腺癌病例（556例）略多于预期（n = 508.37；标准化发病率= 1.09,95%可信区间[CI] 1.00-1.19）。大约有3663名妇女曾经使用过激素替代疗法。在Cox回归模型中，对乳腺癌发病时间与HRT使用时间和类型的关系进行了分析，调整了月经初潮年龄、首次足月妊娠年龄、胎次、绝经年龄、乳腺癌家族史和访谈年龄。在自然绝经的妇女中，联合持续使用HRT的时间越长，与从未使用过的妇女相比，观察到明显更高的风险（危险比[HR] 4.60, 95% CI = 2.39-8.84）。较长联合序列（HR = 2.23, 95% CI = 0.90-5.56）、仅使用孕酮（HR = 3.74, 95% CI = 0.94-14.97）和使用雌三醇（HR = 1.89, 95% CI = 0.81-4.39）也观察到无显著性升高的风险。5年不使用后，未见风险增加。当研究只使用过一种激素替代疗法的女性时，发现含孕激素制剂的hr甚至更高。在使用超过或等于48个月的妇女中，联合持续和仅使用孕激素治疗的风险最高。使用雌二醇而不使用黄体酮不会显著增加乳腺癌的风险。作者估计，接受含孕激素治疗大于或等于48个月的50岁女性，随访10年，乳腺癌的累积风险为7% (95% CI = 5.4% -11.4%)，而从未接受过hrt治疗的女性的累积风险为2% （95% CI = 1.6%-2.9%）。长期使用含有孕激素的first可显著增加乳腺癌风险，而使用雌二醇则不会。继续使用黄体酮的风险最高。长期使用黄体酮的人每年患乳腺癌的风险是BRCA1突变携带者的50%。(C) 2003年美国癌症协会。
BACKGROUND. The authors previously reported an increased risk of breast carcinoma with longer duration of hormone replacement therapy (HRT) use. It is unclear if different types of HRT confer different risks.METHODS. in this study, a population-based cohort of 29,508 women were interviewed during 1990-1992 to determine whether there are any differences in breast carcinoma risk according to different types and duration of HRT use.RESULTS. At the end of the follow-up period in December 2001, the cohort constituted 298,649 person-years. Slightly more breast carcinoma cases were seen (n 556) than expected (n = 508.37; standardized morbidity ratio = 1.09, 95% confidence interval [CI] 1.00-1.19). Approximately 3663 women had ever used HRT. In Cox regression models, time to breast carcinoma in relation to duration and type of HRT use was analyzed, adjusting for age at menarche, age at first full-term pregnancy, parity, age at menopause, family history of breast carcinoma, and age at interview. In women with a natural menopause, a significantly higher risk was observed for longer duration of combined continuous HRT use compared with never users (hazard ratio [HR] 4.60, 95% CI = 2.39-8.84). Nonsignificant elevated risks also were observed for longer combined sequential (HR = 2.23, 95% CI = 0.90-5.56), gestagen only (HR = 3.74,9 5% CI = 0.94-14.97), and estriol use (HR = 1.89, 95% CI = 0.81-4.39). No increased risk was seen in women after 5 years of nonuse. When studying women who ever used only one type of HRT, even more elevated HRs for gestagen-containing preparations were seen. The highest risks were associated with the combined continuous and gestagen-only therapy in women with greater than or equal to 48 months of use. Use of estradiol without progestins did not increase breast carcinoma risk significantly. The authors estimated the cumulative risk of breast carcinoma in a 50-year-old woman with gestagen-containing therapies for greater than or equal to 48 months, with a follow-up of 10 years, to be 7% (95% CI = 5.4-11.4%) compared with 2% (95% CI = 1.6%-2.9%) for never-users of HRT.CONCLUSIONS. Longer use of FIRT containing progestins significantly elevates breast carcinoma risk whereas estradiol use does not. Continued use of progestins rendered the highest risks. The yearly risk of breast carcinoma for long-term users of progestins is of the magnitude of 50% the risk of a BRCA1 mutation carrier. (C) 2003 American Cancer Society.