Weiss Linda K, Burkman Ronald T, Cushing-Haugen Kara L, Voigt Lynda F, Simon Michael S, Daling Janet R, Norman Sandra A, Bernstein Leslie, Ursin Giske, Marchbanks Polly A, Strom Brian L, Berlin Jesse A, Weber Anita L, Doody David R, Wingo Phyllis A, McDonald Jill A, Malone Kathleen E, Folger Suzanne G, Spirtas Robert
Population Studies and Prevention Program, Karmanos Cancer Institute at Wayne State University, Detroit, Michigan, USA.
Obstet Gynecol. 2002 Dec;100(6):1148-58. doi: 10.1016/s0029-7844(02)02502-4.
Hormone replacement therapy (HRT) has increased in the United States over the past 2 decades in response to reports of long-term health benefits. A relationship between HRT and breast cancer risk has been observed in a number of epidemiological studies. In 2002, the Women's Health Initiative Randomized Controlled Trial reported an association between continuous combined HRT and breast cancer risk. The objective of this study was to examine the association between breast cancer risk and HRT according to regimen and duration and recency of use.A multicenter, population-based, case-control study was conducted in five United States metropolitan areas from 1994 to 1998. Analyzed were data from 3823 postmenopausal white and black women (1870 cases and 1953 controls) aged 35-64 years. Odds ratios (ORs) were calculated as estimates of breast cancer risk using standard, unconditional, multivariable logistic regression analysis. Potential confounders were included in the final model if they altered ORs by 10% or more. Two-sided P values for trend were computed from the likelihood ratio statistic. Continuous combined HRT was associated with increased breast cancer risk among current users of 5 or more years (1.54; 95% confidence interval 1.10, 2.17). Additionally, a statistically significant trend indicating increasing breast cancer risk with longer duration of continuous combined HRT was observed among current users (P =.01). There were no positive associations between breast cancer risk and other HRT regimens. Our data suggest a positive association between continuous combined HRT and breast cancer risk among current, longer term users. Progestin administered in an uninterrupted regimen may be a contributing factor. Risk dissipates once use is discontinued.
在过去20年里，随着长期健康益处报告的出现，美国激素替代疗法（HRT）的使用有所增加。多项流行病学研究观察到HRT与乳腺癌风险之间存在关联。2002年，妇女健康倡议随机对照试验报告了连续联合HRT与乳腺癌风险之间的关联。本研究的目的是根据治疗方案、使用持续时间和近期使用情况，研究乳腺癌风险与HRT之间的关联。1994年至1998年，在美国五个大都市地区进行了一项基于人群的多中心病例对照研究。分析了3823名年龄在35 - 64岁之间的绝经后白人和黑人女性的数据（1870例病例和1953名对照）。使用标准的无条件多变量逻辑回归分析计算比值比（OR）作为乳腺癌风险的估计值。如果潜在混杂因素使OR改变10%或更多，则将其纳入最终模型。趋势的双侧P值通过似然比统计量计算。在使用5年或更长时间的当前使用者中，连续联合HRT与乳腺癌风险增加相关（1.54；95%置信区间1.10, 2.17）。此外，在当前使用者中观察到一个统计学上显著的趋势，即随着连续联合HRT使用时间延长，乳腺癌风险增加（P = 0.01）。乳腺癌风险与其他HRT方案之间没有正相关。我们的数据表明，在当前长期使用者中，连续联合HRT与乳腺癌风险呈正相关。不间断方案中使用的孕激素可能是一个促成因素。一旦停止使用，风险就会消散。
