Robbins Anthony S, Clarke Christina A
California Cancer Registry, Public Health Institute, 1700 Tribute Rd, Suite 100, Sacramento, CA 95815, USA.
J Clin Oncol. 2007 Aug 10;25(23):3437-9. doi: 10.1200/JCO.2007.11.4132. Epub 2007 Jun 25.
Recently, an unprecedented 1-year 7% decrease in the overall incidence of invasive female breast cancer in the United States was reported. It has been suggested that the decrease resulted from the mass cessation of estrogen-progestin hormone therapy (EPHT) in 2002. We took advantage of California's unique population-based cancer surveillance resources to assess whether regional changes in breast cancer incidence observed between 2001 and 2004 correlated with regional changes in EPHT use between 2001 and 2003.
We obtained statewide cancer registry and California Health Interview Survey (CHIS) EPHT data for almost 3 million non-Hispanic white women age 45 to 74 years, residing in California's 58 counties. We examined trends in the age-adjusted incidence of invasive female breast cancer and compared these with trends in the use of EPHT, after grouping all California counties into three groups based on EPHT use in 2001. We also examined CHIS data on trends in screening mammography. Results In 2001, there were large regional differences in EPHT use and breast cancer incidence. From 2001 to 2004, incidence declined by 8.8% in the counties with the smallest EPHT reductions, by 13.9% in those with intermediate reductions, and by 22.6% in counties with the largest EPHT reductions. Between 2001 and 2003, CHIS data did not show any significant change in the proportion of women who reported having a mammogram in the previous 2 years.
These data support the hypothesis that changes in EPHT use in 2002 may be responsible for significant declines in breast cancer incidence between 2002 and 2003 and sustained through 2004.
最近有报道称，美国侵袭性女性乳腺癌的总体发病率出现了前所未有的1年下降7%的情况。有人认为，这种下降是由于2002年雌激素 - 孕激素激素疗法（EPHT）的大规模停用所致。我们利用加利福尼亚州基于人群的独特癌症监测资源，评估2001年至2004年间观察到的乳腺癌发病率的区域变化是否与2001年至2003年间EPHT使用的区域变化相关。
我们获取了加利福尼亚州58个县近300万年龄在45至74岁之间的非西班牙裔白人女性的全州癌症登记数据和加利福尼亚健康访谈调查（CHIS）的EPHT数据。在根据2001年的EPHT使用情况将所有加利福尼亚州县分为三组后，我们研究了侵袭性女性乳腺癌年龄调整发病率的趋势，并将其与EPHT使用趋势进行比较。我们还研究了CHIS关于乳腺钼靶筛查趋势的数据。结果在2001年，EPHT使用和乳腺癌发病率存在很大的区域差异。从2001年到2004年，EPHT减少最少的县发病率下降了8.8%，减少程度中等的县下降了13.9%，EPHT减少最多的县下降了22.6%。在2001年至2003年间，CHIS数据显示，在前两年报告进行过乳腺钼靶检查的女性比例没有任何显著变化。
这些数据支持这样一种假设，即2002年EPHT使用的变化可能是2002年至2003年间乳腺癌发病率显著下降并持续到2004年的原因。
