Crouchley Kathryn, Wylie Elizabeth, Khong Eric
Epidemiology Branch, Department of Health, East Perth, Western Australia.
J Med Screen. 2006;13(2):93-7. doi: 10.1258/096914106777589588.
The study objectives were three-fold: to estimate the effect of hormone replacement therapy (HRT) use on the sensitivity of mammographic screening; to examine the odds of having an interval cancer as a function of duration of HRT use and to compare the size, grade, lymph node and hormone receptor status of tumours for HRT users and non-users.
Perth, Western Australia, where a free, population-based mammographic screening service targets women aged 50-69 years.
The cohort consisted of 113,310 women who had 119,296 screening episodes between January 1998 and December 1999. Unconditional logistic regression was used to model the odds of having an interval cancer as a function of the effect of the duration of HRT use (measured in years). Using subsequent screening rounds, chi2-tests were used to examine whether HRT users differed from HRT non-users in terms of tumour characteristics.
Ninety-seven screen-detected and 31 interval cancers were diagnosed among women who were on initial screening rounds, and 393 screen-detected and 153 interval cancers were diagnosed among women on subsequent screens, two years post screening. Two-year sensitivity outcomes were significantly lower for HRT users on initial screening rounds. For women on subsequent screening rounds, the odds of having an interval cancer increased with the duration of HRT use (odds ratio 1.09, 95% confidence interval 1.04-1.14, P<0.04) after controlling for age, family history, tumour grade, size and pathology type. The histopathological characteristics of cancers did not differ for HRT users compared with HRT non-users.
The sensitivity of mammographic screening was reduced and the odds of having an interval cancer were increased for HRT users compared with HRT non-users. For women on subsequent screening episodes, the odds of having an interval cancer increased with duration of HRT use.
本研究有三个目标：评估激素替代疗法（HRT）的使用对乳腺钼靶筛查敏感性的影响；研究发生间期癌的几率与HRT使用时长的关系；比较HRT使用者和非使用者肿瘤的大小、分级、淋巴结及激素受体状态。
在西澳大利亚州的珀斯，一项免费的、基于人群的乳腺钼靶筛查服务面向50至69岁的女性。
该队列由113310名女性组成，她们在1998年1月至1999年12月期间进行了119296次筛查。采用无条件逻辑回归模型来分析发生间期癌的几率与HRT使用时长（以年为单位）之间的关系。利用后续的筛查轮次，采用卡方检验来研究HRT使用者和非使用者在肿瘤特征方面是否存在差异。
在初次筛查轮次的女性中，诊断出97例筛查发现的癌症和31例间期癌；在筛查后两年的后续筛查中，393例筛查发现的癌症和153例间期癌被诊断出来。初次筛查轮次中，HRT使用者的两年筛查敏感性结果显著较低。在后续筛查轮次的女性中，在控制了年龄、家族史、肿瘤分级、大小和病理类型后，发生间期癌的几率随HRT使用时长的增加而增加（优势比1.09，95%置信区间1.04 - 1.14，P < 0.04）。与HRT非使用者相比，HRT使用者癌症的组织病理学特征并无差异。
与HRT非使用者相比，HRT使用者的乳腺钼靶筛查敏感性降低，发生间期癌的几率增加。对于后续筛查轮次的女性，发生间期癌的几率随HRT使用时长的增加而增加。
