THE USE OF ESTROGENS AND PROGESTINS AND THE RISK OF BREAST-CANCER IN POSTMENOPAUSAL WOMEN
THE USE OF ESTROGENS AND PROGESTINS AND THE RISK OF BREAST-CANCER IN POSTMENOPAUSAL WOMEN
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DOI：
10.1056/nejm199506153322401
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发表时间：
1995-06-15
影响因子：
158.5
通讯作者：
SPEIZER, FE
中科院分区：
文献类型：
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作者：
COLDITZ, GA;HANKINSON, SE;SPEIZER, FE
背景在雌激素治疗中加入孕激素对绝经后妇女乳腺癌风险的影响存在争议。为了量化绝经后妇女使用激素与乳腺癌风险之间的关系，我们将对护士健康研究参与者的随访延长至1992年。这些妇女被要求每两年完成一次问卷调查，以更新她们的绝经状态、雌激素和雌激素制剂的使用以及任何乳腺癌诊断的信息。在725，550人-年的随访中，我们记录了1935例新诊断的浸润性乳腺癌。与从未使用过激素的绝经后妇女相比，目前仅使用雌激素（相对危险度，1.32; 95%置信区间，1.14至1.54）或雌激素联合孕激素（相对危险度，1.41; 95%置信区间，1.15至1.74）的妇女患乳腺癌的风险显著增加。目前使用激素治疗5至9年的女性患乳腺癌的调整后相对风险为1.46（95%置信区间为1.22至1.74），目前使用激素治疗10年或更长时间的女性也是如此（相对风险为1.46; 95%置信区间为1.20至1.76）。与绝经后激素治疗5年或更长时间相关的乳腺癌风险增加在老年女性中更大（60至64岁女性的相对风险为1.71; 95%置信区间为1.34至2.18）。在服用雌激素5年或5年以上的妇女中，因乳腺癌死亡的相对危险度为1.45（95%置信区间为1.01 ~ 2.09）。在雌激素治疗中加入孕激素并不能降低绝经后妇女患乳腺癌的风险，服用激素的老年妇女患乳腺癌的风险大幅增加，这表明应仔细评估风险和益处之间的权衡。
Background. The effect of adding progestins to estrogen therapy on the risk of breast cancer in postmenopausal women is controversial.Methods. To quantify the relation between the use of hormones and the risk of breast cancer in postmenopausal women, we extended our follow-up of the participants in the Nurses' Health Study to 1992. The women were asked to complete questionnaires every two years to update information on their menopausal status, use of estrogen and progestin preparations, and any diagnosis of breast cancer. During 725,550 person-years of follow-up, we documented 1935 cases of newly diagnosed invasive breastcancer.Results. The risk of breast cancer was significantly increased among women who were currently using estrogen alone (relative risk, 1.32; 95 percent confidence interval, 1.14 to 1.54) or estrogen plus progestin (relative risk, 1.41; 95 percent confidence interval, 1.15 to 1.74), as compared with postmenopausal women who had never used hormones. Women currently taking hormones who had used such therapy for 5 to 9 years had an adjusted relative risk of breast cancer of 1.46 (95 percent confidence interval, 1.22 to 1.74), as did those currently using hormones who had done so for a total of 10 or more years (relative risk, 1.46; 95 percent confidence interval, 1.20 to 1.76). The increased risk of breast cancer associated with five or more years of postmenopausal hormone therapy was greater among older women (relative risk for women 60 to 64 years old, 1.71; 95 percent confidence interval, 1.34 to 2.18). The relative risk of death due to breast cancer was 1.45 (95 percent confidence interval, 1.01 to 2.09) among women who had taken estrogen for five or more years.Conclusions. The addition of progestins to estrogen therapy does not reduce the risk of breast cancer among postmenopausal women, The substantial increase in the risk of breast cancer among older women who take hormones suggests that the trade-offs between risks and benefits should be carefully assessed.