Risks of breast and endometrial cancer after estrogen and estrogen-progestin replacement
Risks of breast and endometrial cancer after estrogen and estrogen-progestin replacement
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DOI：
10.1023/a:1008909128110
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发表时间：
1999-08-01
影响因子：
2.3
通讯作者：
Schairer, C
中科院分区：
文献类型：
--
作者：
Persson, I;Weiderpass, E;Schairer, C
目的：我们研究了11,231名服用不同替代激素方案的瑞典妇女患乳腺癌和子宫内膜癌的风险。方法：从1987-88年到1993年，对所有10,472名有乳腺癌风险的妇女和8,438名有子宫内膜癌风险的妇女进行了跟踪调查，通过记录链接到瑞典国家癌症登记中心。结果：在乳腺癌患者中，雌激素和孕激素联合使用的女性与拒绝摄入或服用激素不足1年的女性相比有明显增加的风险；服药1-6年后的相对风险(RR)=1.4(95%可信区间0.9-2.3)，服药6年以上的RR=1.7(95%可信区间1.1-2.6)。这种超额风险似乎仅限于最近的风险敞口。以非依从者和短期服用者为参照组，我们发现雌激素的单独摄入量与雌激素摄入量无关。仅使用中效雌激素6年或更长时间的妇女患侵袭性子宫内膜癌的风险增加4倍，RR=4.2(95%可信区间2.5-8.4)。长期服用孕激素联合治疗的女性患乳腺癌的风险较低，无显著差异(RR=1.4；95%可信区间0.6-3.3)。结论：我们得出结论：近期长期使用雌激素和孕激素联合治疗可能会增加乳腺癌的风险。单独接触雌激素会显著增加患子宫内膜癌的风险，这种增加可以通过添加孕激素来减少或避免。
Objective: We studied the risk of breast and endometrial cancer in a cohort of 11,231 Swedish women prescribed different replacement hormone regimens.Methods: All 10,472 women at risk of developing breast cancer and 8,438 women at risk of endometrial cancer were followed up from the time of the questionnaire in 1987-88 through 1993, by record-linkages to the National Swedish Cancer Registry. Using data from a questionnaire we analyzed the relationships between hormone exposures and cancer risk, with non-compliers and users of less than 1 year as a reference group.Results: For breast cancer, women reporting use of estrogens combined with progestins had evidence of an increased risk relative to women denying intake or taking hormones for less than 1 year; relative risk (RR) = 1.4 (95% confidence interval 0.9-2.3) after 1-6 years of intake, and RR=1.7 (95% CI 1.1-2.6) after more than 6 years. This excess risk seemed confined to recent exposure. We found no association with intake of estrogens alone using non-compliers and short-term takers as the reference group. The risk of invasive endometrial cancer was increased four-fold in women using medium-potency estrogens alone for 6 years or longer, RR = 4.2 (95% CI 2.5-8.4). Women on such long-term progestin-combined treatment had a lower, non-significant, excess risk (RR = 1.4; 95% CI 0.6-3.3).Conclusions: We conclude that long-term recent use of estrogen-progestin combined replacement therapy may increase the risk of breast cancer. Exposure to estrogen alone substantially elevates the risk of endometrial cancer, an increase that can be reduced or perhaps avoided by adding progestins.