Hormone replacement therapy in relation to breast cancer
Hormone replacement therapy in relation to breast cancer
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DOI：
10.1001/jama.287.6.734
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发表时间：
2002-02-13
影响因子：
120.7
通讯作者：
White, E
中科院分区：
文献类型：
--
作者：
Chen, CL;Weiss, NS;White, E
背景长期激素替代疗法（HRT）的研究表明，乳腺癌的风险增加，但这种关联是否根据癌症的组织学类型而不同尚未得到广泛研究。目的确定HRT与乳腺癌风险之间的关联是否因HRT制剂而异，并在组织学癌症类型之间存在差异。705名绝经后妇女参加了一项巢式病例对照研究，这些妇女年龄在50 - 74岁之间，在1990年7月1日至1995年12月31日之间诊断为原发性浸润性乳腺癌（例），和692名随机选择的年龄匹配的GHC女性成员主要结果测量在诊断前1年结束的5年期间HRT使用持续时间内乳腺癌的发病率和类型，这是从计算机化药房记录中确定的。无论是单独的雌激素还是雌激素加孕激素。长期使用HRT（57个月或更长时间的比值比[OR]，3.07; 95%置信区间[CI]，1.55-6.06）和目前使用联合治疗（OR，3.91; 95% CI，2.05-7.44）与小叶乳腺癌风险增加相关。长期使用HRT与非小叶癌增加50%相关（OR，1.52，57个月或更长时间; 95%CI，1.01-2.29）。结论我们的数据增加了越来越多的证据表明，最近长期使用HRT与乳腺癌的风险增加，这种使用可能特别是与小叶肿瘤。
Context Studies of long-term hormone replacement therapy (HRT) suggest an associated increased risk of breast cancer, but whether this association differs according to histologic type of cancer has not been extensively studied.Objective To determine whether the association between HRT and risk of breast cancer varies by HRT formulation and differs across histologic cancer types.Design, Setting, and Participants Nested case-control study among 705 postmenopausal women enrolled in the Group Health Cooperative of Puget Sound (GHC) who were aged 50 to 74 years and had primary invasive breast cancer diagnosed between July 1, 1990, and December 31, 1995 (cases), and 692 randomly selected aged-matched female members of GHC (controls).Main Outcome Measure Incidence and type of breast cancer by duration of HRT use in the 5-year period ending 1 year before diagnosis, which was ascertained from computerized pharmacy records.Results The incidence of breast cancer, all histologic types combined, was increased by 60% to 85% in recent long-term users of HRT, whether estrogen alone or estrogen plus progestin. Longer use of HRT (odds ratio [OR], 3.07 for 57 months or more; 95% confidence interval [CI], 1.55-6.06) and current use of combination therapy (OR, 3.91; 95% CI, 2.05-7.44) were associated with increased risk of lobular breast cancer. Long-term HRT use was associated with a 50% increase in nonlobular cancer (OR, 1.52 for 57 months or more; 95% CI, 1.01-2.29).Conclusion Our data add to the growing body of evidence that recent long-term use of HRT is associated with an increased risk of breast cancer and that such use may be related particularly to lobular tumors.