CASE-CONTROL STUDY OF POST-MENOPAUSAL ENDOMETRIAL CANCER

激素替代疗法（HRT），以雌激素的形式 替代疗法（ERT）在20世纪60年代和70年代被广泛使用。 20世纪70年代中期的流行病学研究表明， 显著增加子宫内膜癌风险。 最近 基于人群的研究表明，乳腺癌的风险可能 也会增加，尽管程度要小得多。 这些风险 使用ERT必须与明显的有益效果相平衡， ERT在减轻某些绝经期症状方面的作用， 骨质疏松症，最重要的是，可能是冠心病 冠心病（CHD）风险。 为了应对子宫内膜癌风险， 孕激素现在通常在妊娠的最后10-14天加入， 28-天ERT周期（雌激素-孕激素替代疗法，EPRT）。 ERT对CHD的部分有益作用可能会因EPRT而丧失， 可能会增加患乳腺癌的风险。 EPRT的使用会比ERT引起更少的子宫内膜癌，但事实并非如此 很明显EPRT的使用将与较少的子宫内膜癌相关， 比没有HRT;某些论点表明，EPRT的使用将 导致子宫内膜癌风险显著增加。 作为EPRT 增加受欢迎程度，这显然是重要的，无论是从一个 公共卫生的观点，并增加我们对 致癌和其他疾病过程，以监测其影响 子宫内膜癌、乳腺癌和冠心病风险， 其他疾病终点。 考虑到可能的不利影响， 孕激素对冠心病风险-获益方程的影响， 雌孕激素联合治疗子宫内膜癌疗效观察 乳腺癌风险是决定是否广泛使用 这种治疗是合理的。 本项病例对照研究 920例55-64岁的子宫内膜癌病例和920例匹配的邻居 控制解决子宫内膜癌问题。 面对面 将进行结构化访谈：为了便于回忆， 所有已售出的ERT和EPRT制剂的相册将 被利用 所有病例将盲取病理切片 由一位病理学家进行审查，以获得诊断的一致性 并允许通过确定性对结果进行亚组分析， 疾病的诊断和程度。 我们亦会评估 子宫内膜癌与吸烟、饮食和身体的关系 活动

Hormone replacement therapy (HRT), in the form of estrogen replacement therapy (ERT), was widely used in the 1960s and 1970s. In the mid 1970s epidemiologic studies demonstrated that ERT use significantly increased endometrial cancer risk. Recent population-based studies have shown that breast cancer risk may also be increased, although to a much lesser extent. These risks of ERT use have to be balanced against, the clear beneficial effects of ERT in reducing certain menopausal symptoms and osteoporosis, and, most importantly, probably coronary heart disease (CHD) risk. In response to the endometrial cancer risk a progestogen is now commonly added for the last 10-14 days of the 28-day ERT cycle (estrogen-progestogen replacement therapy, EPRT). Part of the beneficial effect of ERT on CHD may be lost with EPRT, and it may be argued that the breast cancer risk may be increased. EPRT use will cause less endometrial cancer than ERT, but it is not clear that EPRT use will be associated with less endometrial cancer than no HRT; certain lines of argument suggest that EPRT use will cause a significant increase in endometrial cancer risk. As EPRT increases in popularity, it is clearly important, both from a public health standpoint and to increase our understanding of carcinogenic and other disease processes, to monitor its effects on endometrial cancer, breast cancer and CHD risk, and possibly other disease endpoints. Given the probable adverse effect of progestogen on the CHD component of the risk-benefit equation, the effect of estrogen-progestogen therapy on endometrial cancer and breast cancer risk is crucial in determining whether widespread use of such therapy is justified. This proposed case-control study of 920 endometrial cancer cases age 55-64 and 920 matched neighborhood controls addresses the endometrial cancer issue. In-person structured interviews will be conducted: to facilitate recall, a photograph album of all ERT and EPRT preparations ever sold will be used. All cases will have their pathology slides blindly reviewed by a single pathologist to attain uniformity of diagnosis and to allow subgroup analysis of the results by certainty of diagnosis and extent of disease. We will also assess the relationships of endometrial cancer to smoking, diet and physical activity.