The risk of breast, endometrial and ovarian cancer in users of hormonal preparations
The risk of breast, endometrial and ovarian cancer in users of hormonal preparations
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DOI：
10.1111/j.1742-7843.2006.pto_277.x
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发表时间：
2006-03-01
影响因子：
3.1
通讯作者：
Bernstein, L
中科院分区：
文献类型：
--
作者：
Bernstein, L
由于内源性激素在乳腺癌、子宫内膜癌和卵巢癌的风险中起着主要作用，因此在绝经前后服用避孕药和激素治疗对风险的影响一直是一个主要问题。大量研究提供了与使用这些制剂相关的风险增加或降低的洞察力。口服避孕药为子宫内膜癌和卵巢癌提供了一个化学预防的机会，因为使用过这些制剂的妇女的风险比没有使用这些制剂的妇女的风险要低得多。与此相平衡的是，使用口服避孕药可能会增加患乳腺癌的风险。对20世纪90年代初进行的一项研究进行的汇总分析发现，只有目前或最近使用避孕药的人患乳腺癌的风险更高，但最近的两项研究提供了相互矛盾的结果，其中一项研究显示，口服避孕药对任何一组女性的风险没有影响，另一项研究表明，使用避孕药会增加风险。在参与观察性研究的女性中，目前或最近使用雌激素治疗的女性，使用时间相对较长，患乳腺癌的风险略有增加；妇女健康倡议试验基于相对较短的雌激素使用时间，结果与这些观察结果一致。雌激素治疗大大增加了子宫内膜癌的风险。它还可能增加患卵巢癌的风险；然而，由于文献不一致，对这一问题还需要更多的研究。雌激素和孕激素的联合治疗每年会增加多达10%的乳腺癌风险。如果只在部分时间内给予孕激素的循环联合治疗，子宫内膜癌的风险并不会增加，而当雌激素和孕激素都每天给予时，风险会降低。与雌激素疗法一样，联合疗法对卵巢癌风险的影响尚不确定。
Because endogenous hormones play a major role in the risk of breast, endometrial and ovarian cancer, the impact on risk of oral contraceptives and of hormonal therapy given at about the time of menopause has been a major concern. Numerous studies provide insight into whether risk is increased or decreased in association with use of these preparations. Oral contraceptives present a chemopreventive opportunity for endometrial cancer and ovarian cancer as risk is dramatically lower among women who have used these preparations than among those who have not. Balanced against this is the potential for risk of breast cancer to be increased with oral contraceptive use. A pooled analysis of studies conducted through the early 1990s found that only current or recent users were at higher risk of breast cancer, but two more recent studies provide conflicting results with one showing no impact of oral contraceptives on risk of any group of women and the other showing an increase in risk with use. Among women participating in observational studies who are current or recent users of oestrogen therapy and who have relatively long durations of use, risk of breast cancer is modestly elevated; results from the Women's Health Initiative trial, based on a relatively short duration of oestrogen use are consistent with these observations. Oestrogen therapy increases endometrial cancer risk dramatically. It may also increase the risk of ovarian cancer; however more study of this issue is needed as the literature is inconsistent. Combined oestrogen and progestin therapy increases breast cancer risk by as much as 10% per year of use. Endometrial cancer risk is not elevated when combined therapy is given in a cyclic manner with progestin administered only part of the time and it is reduced when both oestrogen and progestin are administered on a daily basis. As with oestrogen therapy, the impact of combined therapy on ovarian cancer risk is uncertain.