Menopausal estrogen and estrogen-progestin replacement therapy and breast cancer risk.
Menopausal estrogen and estrogen-progestin replacement therapy and breast cancer risk.
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DOI：
10.1097/00006254-200006000-00022
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发表时间：
2000-01
期刊：
影响因子：
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通讯作者：
C. Schairer;J. Lubin;R. Troisi;S. Sturgeon;L. Brinton;R. Hoover
中科院分区：
文献类型：
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作者：
C. Schairer;J. Lubin;R. Troisi;S. Sturgeon;L. Brinton;R. Hoover
背景使用雌激素-孕激素联合方案的更年期激素替代疗法是否会增加乳腺癌的风险，而不是单独使用雌激素，这一点尚不清楚。目的确定雌激素-孕激素方案是否比单独使用雌激素增加的风险更大。设计1980-1995年全国乳腺癌筛查项目乳腺癌检测示范项目随访资料的队列研究。在全美设立了29个筛查中心。研究对象为46355名绝经后妇女(开始随访时的平均年龄为58岁)。主要结果通过近期、持续时间和激素使用类型来衡量发生乳腺癌的情况。结果在随访期间，共确诊乳腺癌2082例。仅使用雌激素和仅使用雌孕激素的风险增加被限制在过去4年内(相对风险[RR]，1.2[95%可信区间[CI]，1.0-1.4]和1.4[95%可信区间[CI]，1.1-1.8])；在调整了乳房X光检查、绝经年龄、体重指数、教育程度和年龄后，在最近使用雌激素的人群中，每一年仅使用雌激素的相对风险增加0.01%(95%CI，0.002-0.03)，每一年仅使用雌孕激素的相对风险增加0.08(95%CI，0.02-0.16)。与这些估计的同质性检验相关的P值为0.02。在BMI小于或等于24.4 kg/m2的女性中，最近使用雌激素和仅使用雌孕激素的女性中，每年仅使用雌激素和仅使用雌激素的RR分别增加0.03(95%CI，0.01-0.06)和0.12(95%CI，0.02-0.25)。这些关联对于大多数浸润性肿瘤与导管组织学有明显的相关性，而与侵袭性疾病的程度无关。仅使用雌激素或仅使用雌孕激素并不会增加体重较重的女性的风险。结论我们的数据表明，雌激素-孕激素方案比单独使用雌激素方案增加了乳腺癌的风险。
CONTEXT Whether menopausal hormone replacement therapy using a combined estrogen-progestin regimen increases risk of breast cancer beyond that associated with estrogen alone is unknown. OBJECTIVE To determine whether increases in risk associated with the estrogen-progestin regimen are greater than those associated with estrogen alone. DESIGN Cohort study of follow-up data for 1980-1995 from the Breast Cancer Detection Demonstration Project, a nationwide breast cancer screening program. SETTING Twenty-nine screening centers throughout the United States. PARTICIPANTS A total of 46355 postmenopausal women (mean age at start of follow-up, 58 years). MAIN OUTCOME MEASURE Incident breast cancers by recency, duration, and type of hormone use. RESULTS During follow-up, 2082 cases of breast cancer were identified. Increases in risk with estrogen only and estrogen-progestin only were restricted to use within the previous 4 years (relative risk [RR], 1.2 [95% confidence interval [CI], 1.0-1.4] and 1.4 [95% CI, 1.1-1.8], respectively); the relative risk increased by 0.01 (95% CI, 0.002-0.03) with each year of estrogen-only use and by 0.08 (95% CI, 0.02-0.16) with each year of estrogen-progestin-only use among recent users, after adjustment for mammographic screening, age at menopause, body mass index (BMI), education, and age. The P value associated with the test of homogeneity of these estimates was .02. Among women with a BMI of 24.4 kg/m2 or less, increases in RR with each year of estrogen-only use and estrogen-progestin-only use among recent users were 0.03 (95% CI, 0.01-0.06) and 0.12 (95% CI, 0.02-0.25), respectively. These associations were evident for the majority of invasive tumors with ductal histology and regardless of extent of invasive disease. Risk in heavier women did not increase with use of estrogen only or estrogen-progestin only. CONCLUSION Our data suggest that the estrogen-progestin regimen increases breast cancer risk beyond that associated with estrogen alone.