Pratili M A, Gest-Laval C
Centre René-Huguenin, Saint-Cloud, France.
Bull Cancer. 1992;79(7):651-7.
Among 50-year-old women, about 30%, will suffer from osteoporosis resulting in vertebral compression, pain, and possible disablement; this represents a cost of over 4 billion French franco, and therefore necessitates a prevention policy. It has been established that estrogens applied in a dose-dependent manner have a preventive action against bone loss during the treatment period. The action of nor-steroid progestatives and anti-estrogens is likely, although this has not been fully demonstrated. Estrogens, when administered alone, increase the risk of endometrial cancer; however, this risk seems to be reduced by the addition of progestatives over a minimal period of time. Regarding breast cancer, it seems that substitutional hormone treatments for menopause only increase the risk of the above cancer after a prolonged period of over 10 years. The role of progestatives in breast-cancer risk remains uncertain, and is a subject of controversy. It therefore seems justified to prescribe substitutional hormone treatments combining estrogens and progestatives for young women in whom treatment for non hormone-dependent cancers of the cervix, ovary, etc has resulted in castration. For women who have been treated for breast or endometrial cancer, we are of the opinion that the treatment of choice should consist of non-hormonal treatments for prevention of osteoporosis.
在50岁的女性中，约30%会患骨质疏松症，导致椎体压缩、疼痛并可能致残；这造成的花费超过40亿法国法郎，因此需要制定预防政策。已经确定，以剂量依赖方式应用的雌激素在治疗期间对骨质流失有预防作用。非甾体类孕激素和抗雌激素的作用可能存在，尽管尚未得到充分证实。单独使用雌激素会增加子宫内膜癌的风险；然而，在最短一段时间内添加孕激素似乎可降低这种风险。关于乳腺癌，似乎更年期替代激素治疗仅在超过10年的较长时间后才会增加上述癌症的风险。孕激素在乳腺癌风险中的作用仍不确定，是一个有争议的话题。因此，对于因治疗子宫颈、卵巢等非激素依赖性癌症而导致去势的年轻女性，开具雌激素和孕激素联合的替代激素治疗似乎是合理的。对于接受过乳腺癌或子宫内膜癌治疗的女性，我们认为首选治疗应包括预防骨质疏松症的非激素治疗。
