Schairer C, Lubin J, Troisi R, Sturgeon S, Brinton L, Hoover R
National Cancer Institute, Division of Cancer Epidemiology and Genetics, Rockville, MD 20852-7234, USA.
JAMA. 2000 Jan 26;283(4):485-91. doi: 10.1001/jama.283.4.485.
Whether menopausal hormone replacement therapy using a combined estrogen-progestin regimen increases risk of breast cancer beyond that associated with estrogen alone is unknown.
To determine whether increases in risk associated with the estrogen-progestin regimen are greater than those associated with estrogen alone.
Cohort study of follow-up data for 1980-1995 from the Breast Cancer Detection Demonstration Project, a nationwide breast cancer screening program.
Twenty-nine screening centers throughout the United States.
A total of 46355 postmenopausal women (mean age at start of follow-up, 58 years).
Incident breast cancers by recency, duration, and type of hormone use.
During follow-up, 2082 cases of breast cancer were identified. Increases in risk with estrogen only and estrogen-progestin only were restricted to use within the previous 4 years (relative risk [RR], 1.2 [95% confidence interval [CI], 1.0-1.4] and 1.4 [95% CI, 1.1-1.8], respectively); the relative risk increased by 0.01 (95% CI, 0.002-0.03) with each year of estrogen-only use and by 0.08 (95% CI, 0.02-0.16) with each year of estrogen-progestin-only use among recent users, after adjustment for mammographic screening, age at menopause, body mass index (BMI), education, and age. The P value associated with the test of homogeneity of these estimates was .02. Among women with a BMI of 24.4 kg/m2 or less, increases in RR with each year of estrogen-only use and estrogen-progestin-only use among recent users were 0.03 (95% CI, 0.01-0.06) and 0.12 (95% CI, 0.02-0.25), respectively. These associations were evident for the majority of invasive tumors with ductal histology and regardless of extent of invasive disease. Risk in heavier women did not increase with use of estrogen only or estrogen-progestin only.
Our data suggest that the estrogen-progestin regimen increases breast cancer risk beyond that associated with estrogen alone.
采用雌激素 - 孕激素联合方案的绝经后激素替代疗法是否会增加乳腺癌风险，超出单独使用雌激素时的风险，目前尚不清楚。
确定雌激素 - 孕激素方案相关的风险增加是否大于单独使用雌激素时的风险增加。
对乳腺癌检测示范项目1980 - 1995年随访数据的队列研究，该项目是一项全国性乳腺癌筛查计划。
美国29个筛查中心。
共46355名绝经后女性（随访开始时的平均年龄为58岁）。
根据激素使用的近期情况、持续时间和类型划分的新发乳腺癌病例。
随访期间，共确诊2082例乳腺癌病例。单独使用雌激素和单独使用雌激素 - 孕激素时的风险增加仅限于过去4年内使用（相对风险[RR]分别为1.2[95%置信区间[CI]，1.0 - 1.4]和1.4[95%CI，1.1 - 1.8]）；在调整了乳腺钼靶筛查、绝经年龄、体重指数（BMI）、教育程度和年龄后，近期使用者中，单独使用雌激素每使用一年，相对风险增加0.01（95%CI，0.002 - 0.03），单独使用雌激素 - 孕激素每使用一年，相对风险增加0.08（95%CI，0.02 - 0.16）。这些估计值的同质性检验的P值为0.02。在BMI为24.4kg/m²或更低的女性中，近期使用者中单独使用雌激素和单独使用雌激素 - 孕激素每使用一年，RR增加分别为0.03（95%CI，0.01 - 0.06）和0.12（95%CI，0.02 - 0.25）。这些关联在大多数具有导管组织学的浸润性肿瘤中都很明显，且与浸润性疾病的程度无关。体重较重的女性单独使用雌激素或单独使用雌激素 - 孕激素时风险并未增加。
我们的数据表明，雌激素 - 孕激素方案增加的乳腺癌风险超出了单独使用雌激素时的风险。
