Staffa J A, Newschaffer C J, Jones J K, Miller V
Degge Group, Ltd., Arlington, Virginia 22209.
Fertil Steril. 1992 Mar;57(3):473-91.
To provide a worldwide review of all studies that have examined the relationship between progestins, as contained in both contraceptive and postmenopausal replacement therapies, and breast cancer risk. An overview of utilization patterns for progestins, as well as a review of possible biological mechanisms for progestins' action on breast tissue, are also presented.
All major epidemiologic studies conducted since 1980 have been identified through MEDLINE searches through the published literature and personal communications with prominent researchers in the area.
Only studies that specifically examined the effects of progestin use are discussed here; these include investigations of progestins, in combination or singularly, as the main hypothesis or a subgroup analysis.
The majority of studies have examined combination estrogen and progestin products (oral contraceptives), and subgroup analyses of progestins have been impeded by low statistical power and the fact that each progestin possesses different types of pharmacological activity. Only a few studies of long-acting injectable progestins exist, confirming a general lack of specific information on the progesterone-breast cancer relationship. Investigations of the effect on breast cancer of the addition of progestins to postmenopausal replacement therapy have also produced inconsistent results.
To date, there is no consistent evidence of an association between progestins and breast cancer. There is need for further study, particularly of patients in potentially high-risk groups, including those with (1) extended hormone exposure before age 25 and/or first full term pregnancy and (2) exposure in the postmenopausal period.
对所有研究进行全面综述，这些研究探讨了避孕药和绝经后替代疗法中所含孕激素与乳腺癌风险之间的关系。同时还概述了孕激素的使用模式，并综述了孕激素对乳腺组织作用的可能生物学机制。
通过MEDLINE检索已发表文献，并与该领域的知名研究人员进行个人交流，从而识别出1980年以来进行的所有主要流行病学研究。
这里仅讨论专门研究孕激素使用效果的研究；这些研究包括将孕激素联合或单独作为主要假设或亚组分析的调查。
大多数研究考察了雌激素和孕激素联合产品（口服避孕药），而孕激素的亚组分析因统计功效低以及每种孕激素具有不同类型的药理活性这一事实而受到阻碍。关于长效注射用孕激素的研究仅有少数几项，这证实了关于孕激素与乳腺癌关系的具体信息普遍缺乏。对在绝经后替代疗法中添加孕激素对乳腺癌影响的调查也产生了不一致的结果。
迄今为止，尚无一致证据表明孕激素与乳腺癌之间存在关联。需要进一步开展研究，尤其是针对潜在高危人群的患者，包括那些（1）25岁之前激素暴露时间延长和/或首次足月妊娠以及（2）绝经后暴露的人群。
