Effect of estrogen and estrogen-progestin replacement regimens on mammographic breast parenchymal density
Effect of estrogen and estrogen-progestin replacement regimens on mammographic breast parenchymal density
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DOI：
10.1200/jco.1997.15.10.3201
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发表时间：
1997-10-01
影响因子：
45.3
通讯作者：
Holmberg, L
中科院分区：
文献类型：
--
作者：
Persson, I;Thurfjell, E;Holmberg, L
目的：激素替代疗法(HRT)可能会增加乳腺X线摄影的密度，但可能会降低敏感性或特异性，如果是这样的话，使用HRT的妇女进行乳腺摄影筛查的好处可能会受到影响。我们评估了HRT方案对乳腺摄影密度的影响取决于年龄的假设。患者和方法：在31,498名接受乳腺摄影筛查的瑞典妇女中，我们选择了554名第一次检查后开始接受HRT的妇女和554名年龄匹配的从未接受过HRT的妇女。采用盲法检查乳腺X线片，评估两次检查之间密度的变化，分级为中度或轻度减少，无变化，或轻度，中度或实质性增加，我们研究了四种HRT方案--仅雌二醇化合物，雌二醇化合物周期性或持续与孕激素联合，以及弱雌激素-并用描述性统计和Logistic回归分析HRT与密度变化之间的关系。结果：接受雌二醇化合物与周期或连续联合孕激素的妇女密度分别增加了10%和28%，而非接触者只有3%。Logistic回归分析显示，接受周期联合方案或持续联合方案(RR=12.4；95%CI，6.3至24.4)的妇女密度增加的风险增加(相对风险[RR]=3.6；95%可信区间[CI]，1.6至7.7)，与未暴露的妇女相比，年龄大于或等于50岁的妇女有更强的相关性；单用雌二醇组、周期联合组和连续联合组的RR分别为32.2(95%CI，3.9~267.5)、2 1.9(95%CI，1.9~251.5)和176.9(95%CI，2 2.8~1,372.7)。(C)1997年，由美国临床肿瘤学会主办。
Purpose: Hormone replacement therapy (HRT) may increase the mammographic density with a possible reduction in the sensitivity or specificity, If so, the benefit of mammographic screening in women using HRT could be compromised, We evaluated the hypothesis that HRT regimens have differential effects on the mammographic density depending on treatment regimens ol on age.Patients and Methods: Among 31,498 Swedish women who received mammographic screening, we selected 554 women who started HRT after the first examination and who were current users at the second, and 554 age-matched women who had never received HRT. Mammograms were examined in a blinded review, The changes in density between the two examinations, graded as moderate or weak reduction, no change, or weak, moderate, or substantial increase, were assessed, We studied four HRT regimens-estradiol compounds only, estradiol compounds cyclically or continuously combined with progestins, and weak estrogens-and used descriptive statistics and logistic regression to analyze the association between HRT and density change.Results: Density increased in 10% and 28% of women who received estradiol compounds with cyclically or continuously combined progestins, respectively, but in only 3% of unexposed women. Logistic regression analyses showed an elevated risk of a density increase (relative risk [RR] = 3.6; 95% confidence interval [CI], 1.6 to 7.7) in women who received cyclically combined regimens or continuously combined regimens (RR = 12.4; 95% CI, 6.3 to 24.4) compared with unexposed women, Women greater than or equal to 50 years of age had even stronger associations; RRs in women on estradiol only, the cyclically combined and the continuously combined regimens were 32.2 (95% CI, 3.9 to 267.5), 21.9 (95% CI, 1.9 to 251.5), and 176.9 (95% CI, 22.8 to 1,372.7), respectively.Conclusion: HRT with estradiol-progestin regimens, especially continuously combined, may increase the mammographic density in ct substantial proportion of women. (C) 1997 by American Society of Clinical Oncology.