Relationship between estrogen levels, use of hormone replacement therapy, and breast cancer
Relationship between estrogen levels, use of hormone replacement therapy, and breast cancer
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DOI：
10.1093/jnci/90.11.814
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发表时间：
1998-06-03
影响因子：
10.3
通讯作者：
Colditz, GA
中科院分区：
文献类型：
--
作者：
Colditz, GA
我们试图确定雌激素和绝经后替代激素在乳腺癌发生中起作用的证据的强度。我们回顾了MEDLINE（R）中现有的关于激素和乳腺癌的英文文献，包括关于细胞增殖和内源性激素水平的报告，以及关于绝经后激素使用与女性乳腺癌风险之间关系的流行病学研究。希尔标准证明了环境因素和疾病之间的联系，用于审查女性激素和乳腺癌之间的因果关系的证据。我们发现这些激素和乳腺癌之间存在因果关系的证据，基于以下标准：一致性，剂量反应模式，生物相容性，时间性，关联强度和一致性。每年使用激素增加乳腺癌风险的幅度与推迟绝经一年的风险相当。绝经后妇女内源性激素水平与乳腺癌风险之间的正相关性支持了激素使用与乳腺癌风险增加之间关系的生物学机制。乳腺癌风险的增加与激素使用时间的增加相关，这一发现在不同研究中没有实质性差异，这为因果关系提供了进一步的证据。我们的结论是，现有的证据支持雌激素和孕激素的使用，内源性雌激素的水平，和绝经后妇女乳腺癌的发病率之间的因果关系，激素可能会促进绝经后妇女的晚期癌变，并促进恶性细胞的增殖。迫切需要不引起乳腺癌的策略来缓解更年期症状和长期预防骨质疏松症和心脏病。
We sought to determine the strength of the evidence suggesting that estrogen and postmenopausal replacement hormones play a role in the development of breast cancer. We reviewed the existing English language literature in MEDLINE(R) on hormones and breast cancer, including reports on cell proliferation and endogenous hormone levels, as well as epidemiologic studies of the relationship between the use of postmenopausal hormones and the risk of breast cancer in women, A factor that increases the probability that cancer will develop in an individual has been defined as a cancer cause. The Hill criteria for demonstrating a link between environmental factors and disease were used to review the evidence for a causal relationship between female hormones and breast cancer. We found evidence of a causal relationship between these hormones and breast cancer, based on the following criteria: consistency, dose-response pattern, biologic plausibility, temporality, strength of association, and coherence. The magnitude of the increase in breast cancer risk per year of hormone use is comparable to that associated with delaying menopause by a year. The positive relationship between endogenous hormone levels in postmenopausal women and risk of breast cancer supports a biologic mechanism for the relationship between use of hormones and increased risk of this disease. The finding that the increase in risk of breast cancer associated with increasing duration of hormone use does not vary substantially across studies offers further evidence for a causal relationship. We conclude that existing evidence supports a causal relationship between use of estrogens and progestins, levels of endogenous estrogens, and breast cancer incidence in postmenopausal women, Hormones may act to promote the late stages of carcinogenesis among postmenopausal women and to facilitate the proliferation of malignant cells. Strategies that do not cause breast cancer are urgently needed for the relief of menopausal symptoms and the long-term prevention of osteoporosis and heart disease.