Shantakumar Sumitra, Terry Mary Beth, Paykin Andrea, Teitelbaum Susan L, Britton Julie A, Moorman Patricia G, Kritchevsky Stephen B, Neugut Alfred I, Gammon Marilie D
Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill, NC, USA.
Am J Epidemiol. 2007 May 15;165(10):1187-98. doi: 10.1093/aje/kwm006. Epub 2007 Mar 3.
It is unclear whether breast cancer risk varies by age and menopausal status in relation to use of hormonal birth control (HBC) and hormone replacement therapy (HRT), taken singly or cumulatively. The authors utilized data from 1,478 cases and 1,493 controls aged 20-98 years with known menopausal status, who had participated in a population-based, case-control study conducted on Long Island during 1996-1997. Exogenous hormone use over the lifecourse was assessed by use of memory aids. The authors examined associations among women in these subgroups: premenopausal (n = 968), postmenopausal <65 years (n = 1,045), and postmenopausal > or = 65 years (n = 958). Among premenopausal women, risk was increased for ever use of HBC (odds ratio (OR) = 1.37, 95% confidence interval (CI): 1.04, 1.81) or HRT (OR = 1.81, 95% CI: 1.17, 2.81) and was pronounced among women reporting use of both HBC and HRT (OR = 2.59, 95% CI: 1.50, 4.46), long-term HRT use (OR = 3.93, 95% CI: 1.43, 10.84), or estrogen-plus-progestin therapy (OR = 3.51, 95% CI: 1.45, 8.49). There was no effect of ever HBC use among postmenopausal women aged less than 65 years, but risk was modestly elevated for more than 5 years of HRT use (OR = 1.41, 95% CI: 1.00, 1.99). Among postmenopausal women aged 65 years or more, odds ratios for HBC or HRT use were around the null. These results emphasize that timing of exogenous hormone use is important. Women who used these hormones before menopause had elevated risks, but the harmful effects began to decline with age after menopause.
目前尚不清楚，单独或累积使用激素避孕（HBC）和激素替代疗法（HRT）时，乳腺癌风险是否会因年龄和绝经状态而有所不同。作者利用了1478例病例和1493例年龄在20 - 98岁、绝经状态已知的对照的数据，这些人参与了1996 - 1997年在长岛进行的一项基于人群的病例对照研究。通过使用记忆辅助工具来评估一生中的外源性激素使用情况。作者研究了这些亚组女性之间的关联：绝经前（n = 968）、绝经后<65岁（n = 1045）和绝经后≥65岁（n = 958）。在绝经前女性中，曾经使用HBC（比值比（OR）= 1.37，95%置信区间（CI）：1.04，1.81）或HRT（OR = 1.81，95% CI：1.17，2.81）会增加风险，并且在报告同时使用HBC和HRT（OR = 2.59，95% CI：1.50，4.46）、长期使用HRT（OR = 3.93，95% CI：1.43，10.84）或雌激素加孕激素疗法（OR = 3.51，95% CI：1.45，8.49）的女性中风险更为明显。在年龄小于65岁的绝经后女性中，曾经使用HBC没有影响，但使用HRT超过5年会使风险适度升高（OR = 1.41，95% CI：1.00，1.99）。在65岁及以上的绝经后女性中，使用HBC或HRT的比值比接近无效值。这些结果强调外源性激素使用的时机很重要。在绝经前使用这些激素的女性风险升高，但绝经后随着年龄增长，有害影响开始下降。
