Reeves Gillian K, Beral Valerie, Green Jane, Gathani Toral, Bull Diana
Cancer Research UK Epidemiology Unit, University of Oxford, UK.
Lancet Oncol. 2006 Nov;7(11):910-8. doi: 10.1016/S1470-2045(06)70911-1.
Little information is available on how the risk of breast cancer associated with the use of hormone therapy for menopause varies by histological type. We aimed to describe such associations for eight histological types of breast cancer.
Analyses are based on 1 031 224 postmenopausal women recruited in 1996-2001 into a nationwide UK cohort study, and followed for incident cancer and death. Relative risks associated with use of hormone therapy were estimated for eight histological types of breast cancer.
During 3.6 million person-years of follow-up, 14 102 breast cancers were diagnosed, of which 13 782 (98%) had histological type recorded: 11 869 (86%) were invasive, including 8007 ductal, 1526 lobular, 365 mixed ductal-lobular, 492 tubular, 71 medullary, and 148 mucinous cancers; and 1913 (14%) were in situ, including 1443 ductal and 86 lobular cancers. The relative risks of invasive breast cancer in current users compared with never users of hormone therapy varied significantly according to tumour histology overall (p<0.0001), for users of oestrogen-only therapy (p=0.0001), and for users of oestrogen-progestagen therapy (p<0.0001). The largest relative risks in current compared with never users of hormone therapy were seen for lobular (relative risk 2.25, 95% CI 2.00-2.52), mixed ductal-lobular (2.13, 1.68-2.70), and tubular cancers (2.66, 2.16-3.28). The relative risks for ductal and mucinous cancers were 1.63 (95% CI 1.55-1.72) and 1.58 (1.08-2.31), respectively. The risk of medullary cancer was not increased (0.74, 0.43-1.28). The relative risk of in-situ disease in current users compared with never users of hormone therapy also varied significantly according to histological type (p=0.03), with a relative risk for lobular carcinoma in situ of 2.82 (1.72-4.63) and 1.56 (1.38-1.75) for ductal carcinoma in situ. The effects of hormone therapy on invasive ductal, lobular, and tubular cancer were generally greater for oestrogen-progestagen therapy than for oestrogen-only therapy, and were attenuated with increasing body-mass index (BMI).
The risks associated with use of hormone therapy for menopause differ by histological type of breast cancer, and are substantially attenuated with increasing BMI.
关于更年期激素治疗相关的乳腺癌风险如何因组织学类型而异，目前可用信息较少。我们旨在描述与八种乳腺癌组织学类型的此类关联。
分析基于1996 - 2001年招募的1031224名绝经后女性，她们参与了一项全英国队列研究，并随访其癌症发病和死亡情况。估计了与激素治疗使用相关的八种乳腺癌组织学类型的相对风险。
在360万人年的随访期间，共诊断出14102例乳腺癌，其中13782例（98%）记录了组织学类型：11869例（86%）为浸润性癌，包括8007例导管癌、1526例小叶癌、365例混合性导管 - 小叶癌、492例管状癌、71例髓样癌和148例黏液癌；1913例（14%）为原位癌，包括1443例导管原位癌和86例小叶原位癌。当前使用激素治疗的女性与从未使用过激素治疗的女性相比，浸润性乳腺癌的相对风险根据肿瘤组织学总体存在显著差异（p<0.0001），对于仅使用雌激素治疗的女性（p = 0.0001）以及使用雌激素 - 孕激素治疗的女性（p<0.0001）也是如此。与从未使用激素治疗的女性相比，当前使用激素治疗的女性中，小叶癌（相对风险2.25，95%可信区间2.00 - 2.52）、混合性导管 - 小叶癌（2.13，1.68 - 2.70）和管状癌（2.66，2.16 - 3.28）的相对风险最高。导管癌和黏液癌的相对风险分别为1.63（95%可信区间1.55 - 1.72）和1.58（1.08 - 2.31）。髓样癌风险未增加（0.74，0.43 - 1.28）。当前使用激素治疗的女性与从未使用激素治疗的女性相比，原位疾病的相对风险也根据组织学类型存在显著差异（p = 0.03），小叶原位癌的相对风险为2.82（1.72 - 4.63），导管原位癌为1.56（1.38 - 1.75）。激素治疗对浸润性导管癌、小叶癌和管状癌的影响，雌激素 - 孕激素治疗通常比仅使用雌激素治疗更大，且随着体重指数（BMI）增加而减弱。
更年期激素治疗相关风险因乳腺癌组织学类型而异，且随着BMI增加而大幅减弱。
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