Li Christopher I, Malone Kathleen E, Porter Peggy L, Lawton Thomas J, Voigt Lynda F, Cushing-Haugen Kara L, Lin Ming Gang, Yuan Xiaopu, Daling Janet R
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Seattle, WA 98109-1024, USA.
Cancer Epidemiol Biomarkers Prev. 2008 Jan;17(1):43-50. doi: 10.1158/1055-9965.EPI-07-0558.
Combined estrogen and progestin hormone therapy (CHT) increases breast cancer risk, but this risk varies by breast cancer type. Several studies indicate that CHT is more strongly related to lobular carcinoma risk than to ductal carcinoma risk, but these studies have been limited in their assessments of recency and duration of use, and none included a centralized pathology review. We conducted a population-based case-control study consisting of 324 lobular, 196 ductal-lobular, and 524 ductal cases diagnosed from 2000 to 2004 and 469 controls ages 55 to 74 years old. Tissue specimens were centrally reviewed for 83% of cases. Associations between hormone use and breast cancer risk were evaluated using polytomous logistic regression. Current CHT users had 2.7-fold [95% confidence interval (95% CI), 1.7-4.2] and 3.3-fold (95% CI, 2.0-5.7) elevated risks of lobular and ductal-lobular carcinomas, respectively, regardless of tumor stage, size, or nodal status. Elevations in risk were observed only among users of CHT for > or =3 years. Among ductal-lobular cases, CHT increased risk of tumors that were > or =50% lobular (odds ratio, 4.8; 95% CI, 2.1-11.1) but not tumors that were <50% lobular (odds ratio, 1.9; 95% CI, 0.9-4.1). Current CHT users for > or =3 years have a substantially increased risk of lobular carcinomas. Although lobular carcinomas are less common than ductal carcinomas ( approximately 16% versus 70% of all invasive breast cancers in the United States), this duration is shorter than the 5 years of use widely cited to be needed to confer an increased risk of breast cancer overall. Further studies focusing on the etiology of lobular carcinomas are needed.
雌激素和孕激素联合激素疗法（CHT）会增加患乳腺癌的风险，但这种风险因乳腺癌类型而异。多项研究表明，CHT与小叶癌风险的关联比与导管癌风险的关联更强，但这些研究在使用的近期性和持续时间评估方面存在局限性，且均未纳入集中病理审查。我们进行了一项基于人群的病例对照研究，研究对象包括2000年至2004年诊断出的324例小叶癌、196例导管小叶癌和524例导管癌病例，以及469名年龄在55至74岁之间的对照者。对83%的病例的组织标本进行了集中审查。使用多分类逻辑回归评估激素使用与乳腺癌风险之间的关联。当前使用CHT的患者，无论肿瘤分期、大小或淋巴结状态如何，患小叶癌和导管小叶癌的风险分别升高了2.7倍[95%置信区间（95%CI），1.7 - 4.2]和3.3倍（95%CI，2.0 - 5.7）。仅在使用CHT≥3年的使用者中观察到风险升高。在导管小叶癌病例中，CHT增加了小叶成分≥50%的肿瘤的风险（比值比，4.8；95%CI，2.1 - 11.1），但未增加小叶成分<50%的肿瘤的风险（比值比，1.9；95%CI，0.9 - 4.1）。当前使用CHT≥3年的使用者患小叶癌的风险大幅增加。尽管小叶癌比导管癌少见（在美国所有浸润性乳腺癌中约占16%对70%），但这个使用持续时间比广泛引用的总体上增加患乳腺癌风险所需的5年时间要短。需要进一步开展针对小叶癌病因的研究。
