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閉経期ホルモン療法で治療されている閉経期患者の乳がんリスクを評価するにはどうすればよいですか

Serge Rozenberg¹, Chloé Taelman¹, Jean Vandromme¹

¹Department of Obstetrics and Gynecology, CHU Saint-Pierre, Université libre de Bruxelles and Vrije Universiteit Brussel, Brussels, Belgium.

Expert review of endocrinology & metabolism

|August 22, 2025

まとめ

更年期ホルモン療法 (MHT) の使用は,個々の患者のリスク,特に乳がん (BC) のリスクを慎重に評価する必要があります. MHTの意思決定には,BCリスクの見積もりを考慮し,潜在的な害と利益のバランスをとる必要があります.

科学分野:

内分泌学
腫瘍学
女性の健康

背景:

閉経期ホルモン療法 (MHT) は,高潮症状と骨粗鬆症に処方されています.
MHTを開始する前に,個々の患者のリスクを評価することが重要です.
乳がん (BC) のリスクは,MHT投与の主要な懸念事項です.

研究の目的:

MHT使用に関連する生涯のBCリスクと死亡率の見直し.
BCリスクの推定に基づいてMHT投与に関するガイドラインを提供すること.
MHTの利益とBCのリスクのバランスを評価する.

主な方法:

MHTに関連した生涯BCリスクと死亡率のレビュー
変えない要因 (個人/家族歴,乳腺密度) を用いてBCリスクを推定する.
変更可能な因子 (例えばアルコール摂取量) を使用してBCリスクを推定する.

主要な成果:

クライマクター症候群または骨粗鬆症候群の患者にMHTは好ましいかもしれない.
患者特有の様々な要因を用いてBCのリスクを推定することができます.
予測モデルは複雑なケースでの意思決定に役立ちます.

結論:

5年後のBCリスクが3%以下である場合,MHTを処方することができます.
3%から6%のBCリスクについては注意が必要です.
5年間のBCリスクが6%を超えると,MHTは一般的に避けるべきです.

キーワード:

閉経ホルモン療法乳がんエストロゲンホルモン補充療法閉経プロゲスティンリスク

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