Kumar Anjali S, Cureton Elizabeth, Shim Veronica, Sakata Theadora, Moore Dan H, Benz Christopher C, Esserman Laura J, Hwang E Shelley
Department of Surgery, Kaiser Permanente Oakland Medical Center, Oakland, California, 94602, USA.
Ann Surg Oncol. 2007 Feb;14(2):695-703. doi: 10.1245/s10434-006-9129-2. Epub 2006 Nov 14.
It is unclear whether hormone replacement therapy (HRT), in addition to increasing risk for breast cancer, affects the type of breast cancer diagnosed. We conducted this investigation to assess whether the type of hormone used (none, estrogen, progesterone, or combined) and duration of use influences subsequent breast cancer histology.
We performed a retrospective cohort analysis among women listed as incident cases of breast malignancy in the Kaiser Permanente Northern California Cancer Registry during 2003 (n = 2830). Type and duration of hormone used (none, estrogen, progesterone, or combined) before breast cancer diagnosis was obtained from electronic pharmacy records. The association between type and duration of hormone use with characteristics of subsequent breast cancers was examined.
Among women aged >50 years (n = 1701), any use of estrogen, progesterone, or combination therapy was not associated with an increased risk of estrogen receptor (ER)-positive disease. However, >6 months' use of combined HRT increased the odds of ER-positive tumors (odds ratio, 1.65; 95% confidence interval, 1.07-2.5; P = .02). Estrogen HRT patients were more likely than nonusers to present with low-grade (P = .05), and early-stage tumors (P = .03). This trend was not seen in combined HRT users.
Short-duration HRT did not increase the likelihood of ER-positive breast cancer. However, prolonged duration of combined HRT, but not estrogen or progesterone alone, resulted in a marked increase in ER-positive disease. Our findings suggest that the effect of combined HRT on breast cancer incidence or progression is not immediate and that long-term use is more likely to affect breast cancer histology.
除了增加患乳腺癌的风险外，激素替代疗法（HRT）是否会影响所诊断出的乳腺癌类型尚不清楚。我们开展此项调查以评估所使用激素的类型（无、雌激素、孕激素或联合使用）及使用时长是否会影响后续乳腺癌的组织学类型。
我们对2003年列入北加利福尼亚凯撒医疗集团癌症登记处的乳腺癌恶性肿瘤确诊病例女性（n = 2830）进行了一项回顾性队列分析。乳腺癌诊断前使用激素的类型及时长（无、雌激素、孕激素或联合使用）从电子药房记录中获取。研究了激素使用类型及时长与后续乳腺癌特征之间的关联。
在年龄大于50岁的女性（n = 1701）中，使用任何雌激素、孕激素或联合疗法均与雌激素受体（ER）阳性疾病风险增加无关。然而，联合使用激素替代疗法超过6个月会增加ER阳性肿瘤的几率（优势比，1.65；95%置信区间，1.07 - 2.5；P = 0.02）。使用雌激素替代疗法的患者比未使用者更有可能出现低级别（P = 0.05）和早期肿瘤（P = 0.03）。联合使用激素替代疗法的使用者未出现这种趋势。
短期激素替代疗法不会增加ER阳性乳腺癌的可能性。然而，联合使用激素替代疗法的时间延长（而非单独使用雌激素或孕激素）会导致ER阳性疾病显著增加。我们的研究结果表明，联合使用激素替代疗法对乳腺癌发病率或进展的影响并非立竿见影，长期使用更有可能影响乳腺癌的组织学类型。
