Foidart J M, Desreux J, Pintiaux A
Université de Liège, Département de Gynécologie-Obstétrique, Citadelle Liège.
Rev Med Liege. 2000 Mar;55(3):156-60.
The study by Schairer et al. aims to determine whether increases in risk of breast cancer associated with the estrogen-progestin regimen are greater than those associated with estrogen alone. This study is a cohort of follow-up data for 1980-1995 from the Breast Cancer Detection Demonstration Project, a nationwide breast cancer screening program that involved 29 screening centers throughout the United States. A total of 46,355 postmenopausal women were followed. During follow up, 2,082 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. The relative risk increased by 0.01 with each year of estrogen-only use and by 0.08 with each year of estrogen-progestin-only use among recent users. Among women with a Body Mass Index of 24.4 kg/m2 or less, increases in relative risk with each year of estrogen-only use and estrogen-progestin-only use among recent users were 0.03 and 0.12, respectively. The authors conclude that the estrogen-progestin regimen increases breast cancer risk beyond that associated with estrogen alone. This study was largely commented in the lay media. Unfortunately the Belgian media introduced the confusion between the relative risk and the risk attributable to estrogen and estrogen-progestin. The aim of this manuscript is to precisely inform our colleagues, to analyze the Schairer study and to present the actual figures of risk associated with the use of estrogen and estrogen-progestin replacement therapy. Finally, we formulate some suggestions for the physician to whom the patient declares: "Did you read the negative effects of hormones?". What should we advice?
沙伊雷尔等人开展的这项研究旨在确定，与单独使用雌激素疗法相比，雌激素 - 孕激素疗法所导致的乳腺癌风险增加幅度是否更大。本研究采用了乳腺癌检测示范项目1980 - 1995年的队列随访数据，该项目是一项全国性的乳腺癌筛查计划，涉及美国各地的29个筛查中心。总共对46355名绝经后女性进行了随访。随访期间，共确诊2082例乳腺癌病例。仅雌激素和仅雌激素 - 孕激素使用导致的风险增加仅限于过去4年内的使用情况。近期使用者中，每年仅使用雌激素的相对风险增加0.01，每年仅使用雌激素 - 孕激素的相对风险增加0.08。在体重指数为24.4kg/m²或更低的女性中，近期使用者每年仅使用雌激素和仅使用雌激素 - 孕激素导致的相对风险增加分别为0.03和0.12。作者得出结论，雌激素 - 孕激素疗法导致的乳腺癌风险增加幅度超过单独使用雌激素疗法。这项研究在大众媒体上得到了大量报道。遗憾的是，比利时媒体混淆了相对风险与雌激素和雌激素 - 孕激素所致风险。本文的目的是准确地告知我们的同行，分析沙伊雷尔的研究，并给出与使用雌激素和雌激素 - 孕激素替代疗法相关的实际风险数据。最后，对于患者询问“您读过激素的副作用吗？”的医生，我们给出一些建议。我们应该给出什么建议呢？
