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更年期中のエストロゲンおよびエストロゲン・プロゲステンの置換療法と乳がんのリスク
C Schairer1, J Lubin, R Troisi
1National Cancer Institute, Division of Cancer Epidemiology and Genetics, Rockville, MD 20852-7234, USA. schairec@exchange.nih.gov
JAMA
|February 5, 2000
まとめ
併用ホルモン置換療法 (HRT) は,エストロゲン単独療法と比較して,乳がんのリスクを大幅に増加させます. この研究では,エストロゲンとプロゲステンの使用は,特に最近のユーザーと痩せた女性において,より大きなリスク増加につながったことが判明しました.
科学分野:
- 腫瘍学 腫瘍学
- 内分泌学 エンドックリノロジー
- エピデミオロジー エピデミオロジー
背景:
- エストロゲンとプロゲステンの併用更年期ホルモン置換療法 (HRT) と,エストロゲン単独のHRTとの比較リスクの比較は不明である.
- これらの差異的なリスクを理解することは,HRTの処方慣行と患者カウンセリングを導くために非常に重要です.
研究 の 目的:
- エストロゲンとプロゲステンを併用したHRTによる乳がんリスクの増加が,エストロゲン単独のHRTで観察されたものより大きいかどうかを調査する.
- ホルモン使用の期間と最近によってリスクを分析する.
主な方法:
- 乳がん検出実証プロジェクトから1980年から1995年のフォローアップデータを活用したコホート研究.
- 米国内の29のスクリーニングセンターで46,355人の閉経後の女性を対象に実施した.
- インシデント乳がんは,ホルモン療法の種類,最近,および期間に関連して分析され,BMI,年齢,更年期要因を調整しました.
主要な成果:
- エストロゲンとプロゲステンを併用したHRTは,エストロゲンのみのHRT (1.2) に比べて,乳がん (1.4) の相対リスク (RR) が高いことを最近のユーザー (4年以内に) で示した.
- RRの年間増加は,エストロゲン-プロゲステン (0.08) の場合,エストロゲンのみ (0.01) の使用よりも,最近のユーザーの間で著しく高かった.
- BMI ≤24.4kg/m2の女性では,HRTを併用した場合の年間リスク増加は0.12であり,エストロゲンのみのHRTでは0.03であった.
結論:
- 研究結果は,エストロゲンとプロゲステンの併用HRTが,エストロゲン単独のHRTよりも乳がんリスクを大幅に高めることを示唆しています.
- リスクの増加は,特に最近使用した場合,およびボディマス指数が低い女性において顕著です.
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