绝经后的雌激素/乳腺癌争议
1Department of Medicine, Yale University School of Medicine, New Haven, Conn.
JAMA
|October 14, 1992
概括
绝经后使用雌激素似乎不会增加整体乳腺癌风险. 研究中的差异可能源于检测偏差和雌激素使用的国际差异,这需要对新方案进行进一步研究.
科学领域:
- 内分泌学和瘤学的内分泌学和瘤学.
- 生殖健康和癌症流行病学
背景情况:
- 绝经后雌激素治疗与乳腺癌风险之间的关系仍然是争论的主题.
- 文献中相互矛盾的发现需要对研究方法和潜在的偏见进行批判性评估.
研究的目的:
- 综合现有关于绝经后雌激素使用和乳腺癌风险的证据.
- 识别研究结果中的分歧来源及其临床影响.
- 评估检测偏差对风险估计的影响.
主要方法:
- 系统地搜索MEDLINE的文献,并审查相关元分析的文献资料.
- 包括24篇原创文章和3篇元分析.
- 对5项旨在最大限度地减少检测偏差的研究进行了集中审查.
主要成果:
- 原始文章显示了可变的风险估计,从保护性影响到不良影响.
- 分析没有显示,随着不断使用雌激素,乳腺癌的总体风险显著增加.
- 控制检测偏差的研究表明,常用用户的风险估计为1或更低,对其他使用类别没有一致的影响.
结论:
- 目前的证据不支持与永久使用绝经后雌激素相关的整体乳腺癌风险增加.
- 观察到的差异可能归因于雌激素使用的跨国变化和乳腺癌检测率的差异.
- 建议对较新的雌激素和孕激素对立方案进行进一步的研究.
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