Relationship between long durations and different regimens of hormone therapy and risk of breast cancer
Relationship between long durations and different regimens of hormone therapy and risk of breast cancer
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DOI：
10.1001/jama.289.24.3254
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发表时间：
2003-06-25
影响因子：
120.7
通讯作者：
Daling, JR
中科院分区：
文献类型：
--
作者：
Li, CI;Malone, KE;Daling, JR
使用联合雌激素和孕激素替代疗法（CHRT）的女性患乳腺癌的风险增加;但是，在此情况下，目的通过组织学类型和激素受体状态评估CHRT使用的持续时间和模式与乳腺癌风险之间的关系。对照研究：地点：华盛顿州西部的三个县，参与者：975名65-79岁的妇女，从1997年4月1日至1999年5月31日被诊断为浸润性乳腺癌（组织学：196例小叶病例，656例导管病例，114例其他组织学类型病例，9例未指明组织学类型病例;雌激素受体（ER）/孕激素受体（PR）状态：646例ER+/PR+病例、147例ER+/PR-病例和101例ER-/PR-病例[6例ER-/PR+病例和75例ER/PR状态未知的病例未包括在本文的分析中]）和1007例人群对照。结果使用非对抗性雌激素替代疗法（ERT）（仅使用ERT）的妇女，即使持续25年或更长时间，患乳腺癌的风险也没有明显增加，尽管相关的比值比与可能的小效应并不矛盾。CHRT用户（包括也使用过ERT的CHRT使用者）（95%置信区间（01，1.3-2.2）增加乳腺癌的风险，包括2.7倍，（95%CI，1.7-4.3）浸润性小叶癌的风险增加，（95% CI，1.1-2.0）浸润性导管癌的风险增加，ER+/PR+乳腺癌的风险增加2.0倍（95% CI，1.5-2.7）。在使用CHRT较长时间的患者中，风险增加最大（使用5-14.9年和15年的患者浸润性导管癌风险分别增加1.5倍[95% CI，1.0-2.3]和1.6倍[95% CI，1.0-2.6]，3.7倍[95% CI，2.0-6.6]和2.6倍[95%CI，1.3-5.3]的浸润性小叶癌风险分别增加。在连续和连续CHRT的使用者中观察到类似程度的关联。ER+/PR-和ER-/ PR-肿瘤的风险并没有增加使用任何形式的激素替代疗法，然而，这些肿瘤的数量有限的权力，以检测可能的association.Conclusion这些数据表明，使用CHRT是与乳腺癌的风险增加，特别是浸润性小叶肿瘤，无论是在一个连续的或连续的方式采取的resistin组件。
Context Women using combined estrogen and progestin hormone replacement therapy (CHRT) have an increased risk of breast cancer; however, data on use for long durations and on risk associated with patterns of use are lacking.Objective To evaluate relationships between durations and patterns of CHRT use and risk of breast cancer by histological type and hormone receptor status.Design Population-based case-control study.Setting Three counties in western Washington State.Participants Nine hundred seventy-five women 65-79 years of age diagnosed with invasive breast cancer from April 1, 1997, through May 31, 1999 (histology: 196 lobular cases, 656 ductal cases, 114 cases with other histological type, and 9 cases with an unspecified histological type; estrogen receptor (ER)/progesterone receptor (PR) status: 646 ER+/PR+ cases, 147 ER+/PR- cases, and 101 ER-/PR- cases [6 ER-/PR+ cases and 75 cases with unknown ER/PR status were not included in the analyses herein]) and 1007 population controls.Main Outcome Measures Risks of invasive lobular, ductal, ER+/PR+, ER+/PR-, and ER-/PR- breast carcinomas.Results Women using unopposed estrogen replacement therapy (ERT) (exclusive ERT use), even for 25 years or longer, had no appreciable increase in risk of breast cancer, although the associated odds ratios were not inconsistent with a possible small effect. Ever users of CHRT (includes CHRT users who also had used ERT) had a 1.7-fold (95% confidence interval (01, 1.3-2.2) increased risk of breast cancer, including a 2.7-fold (95% Cl, 1.7-4.3) increased risk of invasive lobular carcinoma, a 1.5-fold (95% Cl, 1.1-2.0) increased risk of invasive ductal carcinoma, and a 2.0-fold (95% Cl, 1.5-2.7) increased risk of ER+/PR+ breast cancers. The increase in risk was greatest in those using CHRT for longer durations (users for 5-14.9 years and 15 years had 1.5-fold [95% Cl, 1.0-2.3] and 1.6-fold [95% Cl, 1.0-2.6] increases in risk of invasive ductal carcinoma, respectively, and 3.7-fold [95% Cl, 2.0-6.6] and 2.6-fold [95% Cl, 1.3-5.3] increases in risk of invasive lobular carcinoma, respectively. Associations of similar magnitudes were seen among users of both sequential and continuous CHRT. Risks of ER+/PR- and ER-/ PR- tumors were not increased by use of any form of hormone replacement therapy; however,,small numbers of these tumors limited power to detect possible associations.Conclusion These data suggest that use of CHRT is associated with an increased risk of breast cancer, particularly invasive lobular tumors, whether the progestin component was taken in a sequential or in a continuous manner.