更年期雌激素和雌激素-孕激素替代疗法以及乳腺癌风险
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
概括
与仅用雌激素治疗相比,组合激素替代疗法 (HRT) 显著增加乳腺癌风险. 这项研究发现,雌激素-孕激素的使用导致了更大的风险增加,特别是在最近的使用者和更瘦的女性中.
科学领域:
- 在瘤学瘤学.
- 内分泌学 在内分泌学.
- 流行病学 流行病学
背景情况:
- 与联合雌激素-孕激素更年期激素替代疗法 (HRT) 与仅用雌激素的HRT相关的乳腺癌的比较风险尚不清楚.
- 了解这些差异性风险对于指导HRT处方实践和患者咨询至关重要.
研究的目的:
- 调查结合雌激素-孕激素HRT增加的乳腺癌风险是否大于仅用雌激素HRT观察到的风险.
- 根据激素使用的持续时间和最近情况分析风险.
主要方法:
- 一项使用乳腺癌检测示范项目的1980-1995年后续数据的队列研究.
- 在美国29个查中心参与了46,355名绝经后妇女.
- 乳腺癌的发病情况与激素治疗的类型,近期和持续时间有关,并对BMI,年龄和更年期因素进行调整.
主要成果:
- 在最近的使用者 (4年内) 中,结合雌激素-孕激素HRT显示乳腺癌的相对风险 (RR) (1.4) 与仅用雌激素的HRT (1.2) 相比较高.
- 在最近的用户中,雌激素-孕激素 (0.08) 的RR年增幅明显高于仅雌激素 (0.01) 的使用.
- 在BMI ≤24.4kg/m2的女性中,每年风险增加为0.12的组合HRT和0.03的仅雌激素HRT;更重的女性没有增加风险.
结论:
- 研究结果表明,结合雌激素和孕激素的HRT比仅含雌激素的HRT更大程度上提高了乳腺癌风险.
- 风险增加在最近使用和身体质量指数较低的女性中尤为明显.
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