Colditz G A, Rosner B
Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA 02115, USA.
Am J Epidemiol. 2000 Nov 15;152(10):950-64. doi: 10.1093/aje/152.10.950.
Because of the temporal relations between reproductive risk factors and incidence of breast cancer, the authors developed a nonlinear Poisson regression that accounts for time and summarizes risk to age 70 years. Reproductive risk factors, benign breast disease, use of postmenopausal hormones, weight, and alcohol intake were evaluated as risk factors. Among 58,520 women aged 30-55 years in 1980, followed through June 1, 1994, 1,761 incident invasive breast cancer cases were identified. All risks are multivariate adjusted. History of benign breast disease is associated with a 57% increase (95% confidence interval (CI): 43%, 73%) in cumulative risk of breast cancer by age 70 years. Use of unopposed postmenopausal estrogen from ages 50-60 years increases risk of breast cancer to age 70 by 23% (95% CI: 6%, 42%) compared with a woman who never uses hormones. Ten years of use of estrogen plus progestin increases risk to age 70 years by 67% (95% CI: 18%, 136%). Compared with never drinking alcohol, one drink per day from age 18 years increases risk to age 70 by 7% (95% CI: 0%, 13%). Use of unopposed postmenopausal hormones for 10 years significantly increases the risk of breast cancer, and the addition of progestin further increases the risk.
由于生殖风险因素与乳腺癌发病率之间存在时间关系,作者开发了一种非线性泊松回归模型,该模型考虑了时间因素并总结了至70岁时的风险。对生殖风险因素、良性乳腺疾病、绝经后激素的使用、体重和酒精摄入量等风险因素进行了评估。在1980年年龄在30 - 55岁的58520名女性中,随访至1994年6月1日,共确诊1761例浸润性乳腺癌病例。所有风险均经过多变量调整。良性乳腺疾病史与至70岁时乳腺癌累积风险增加57%(95%置信区间(CI):43%,73%)相关。与从未使用激素的女性相比,50 - 60岁使用单纯绝经后雌激素会使至70岁时患乳腺癌的风险增加23%(95% CI:6%,42%)。使用10年雌激素加孕激素会使至70岁时的风险增加67%(95% CI:18%,136%)。与从不饮酒相比,从18岁起每天饮用一杯酒至70岁时风险增加7%(95% CI:0%,13%)。使用10年单纯绝经后激素会显著增加患乳腺癌的风险,添加孕激素会进一步增加风险。