Menopausal estrogen and estrogen-progestin replacement therapy and breast cancer risk
Menopausal estrogen and estrogen-progestin replacement therapy and breast cancer risk
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DOI：
10.1001/jama.283.4.485
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发表时间：
2000-01-26
影响因子：
120.7
通讯作者：
Hoover, R
中科院分区：
文献类型：
--
作者：
Schairer, C;Lubin, J;Hoover, R
绝经期激素替代疗法使用雌激素-黄体酮联合治疗方案是否会增加乳腺癌的风险，而不仅仅是单独使用雌激素，目前尚不清楚。目的探讨雌激素-黄体酮联合用药的风险增加是否大于单纯雌激素联合用药。乳腺癌检测示范项目（一个全国性的乳腺癌筛查项目）1980-1995年随访数据的设计队列研究在全美设立了29个筛查中心。参与者共46355名绝经后妇女（随访开始时平均年龄58岁）。主要结局指标：按近期、持续时间和激素使用类型划分的乳腺癌发生率。结果随访期间，共发现乳腺癌2082例。仅使用雌激素和仅使用雌激素-黄体酮的风险增加限制在过去4年内（相对风险[RR]分别为1.2[95%可信区间{CI}， 1.0-1.4]和1.4 [95% CI, 1.1-1.8]）；经乳房x光检查、绝经年龄、身体质量指数（BMI）、教育程度和年龄调整后，最近的使用者中，每年仅使用雌激素的相对风险增加0.01 (95% CI, 0.002-0.03)，每年仅使用雌激素-黄体酮的相对风险增加0.08 （95% CI, 0.02-0.16）。与这些估计的同质性检验相关的P值为0.02。在BMI为24.4 kg/m(2)或更低的女性中，仅使用雌激素和近期仅使用雌激素-黄体酮的女性每年的RR增加分别为0.03 （95% CI, 0.01-0.06）和0.12 （95% CI, 0.02-0.25）。这些关联在大多数具有导管组织学的浸润性肿瘤中都很明显，无论浸润性疾病的程度如何。在体重较重的女性中，仅使用雌激素或仅使用雌激素-黄体酮并不会增加风险。结论：我们的数据表明，雌激素-黄体酮方案增加乳腺癌的风险超过单独雌激素。
Context Whether menopausal hormone replacement therapy using a combined estrogen-progestin regimen increases risk of breast cancer beyond that associated with estrogen alone is unknown.Objective To determine whether increases in risk associated with the estrogen-progestin regimen are greater than those associated with estrogen alone.Design Cohort study of follow-up data for 1980-1995 from the Breast Cancer Detection Demonstration Project, a nationwide breast cancer screening program.Setting Twenty-nine screening centers throughout the United States.Participants A total of 46 355 postmenopausal women (mean age at start of followup, 58 years).Main Outcome Measure Incident breast cancers by recency, duration, and type of hormone use.Results During follow-up, 2082 cases of breast cancer were identified. Increases in risk with estrogen only and estrogen-progestin only were restricted to use within the previous 4 years (relative risk [RR], 1.2 [95% confidence interval {CI}, 1.0-1.4] and 1.4 [95% CI, 1.1-1.8], respectively); the relative risk increased by 0.01 (95% CI, 0.002-0.03) with each year of estrogen-only use and by 0.08 (95% CI, 0.02-0.16) with each year of estrogen-progestin-only use among recent users, after adjustment for mammographic screening, age at menopause, body mass index (BMI), education, and age. The P value associated with the test of homogeneity of these estimates was .02. Among women with a BMI of 24.4 kg/m(2) or less, increases in RR with each year of estrogen-only use and estrogen-progestin-only use among recent users were 0.03 (95% CI, 0.01-0.06) and 0.12 (95% CI, 0.02-0.25), respectively. These associations were evident for the majority of invasive tumors with ductal histology and regardless of extent of invasive disease. Risk in heavier women did not increase with use of estrogen only or estrogen-progestin only.Conclusion Our data suggest that the estrogen-progestin regimen increases breast cancer risk beyond that associated with estrogen alone.