Cui Yan, Page David L, Lane Dorothy S, Rohan Thomas E
Office of Health Assessment and Epidemiology, Los Angeles County Department of Public Health, 313 N. Figueroa Street, Los Angeles, CA 90012, USA.
Breast Cancer Res Treat. 2009 Mar;114(1):113-20. doi: 10.1007/s10549-008-9973-9. Epub 2008 Mar 22.
Menstrual and reproductive history and postmenopausal hormone use are well-established risk factors for breast cancer. However, previous studies that have assessed these factors in association with risk of benign proliferative epithelial disorders (BPED) of the breast, putative precursors of breast cancer, have yielded inconsistent findings. To investigate these associations, we conducted a cohort study among 68,132 postmenopausal women enrolled in the Women's Health Initiative randomized clinical trials. Women were prospectively followed and those reporting an open surgical biopsy or a core needle biopsy had histological sections obtained for centralized pathology review. Over an average of 7.8 years of follow-up, we identified 1,792 women with BPED of the breast. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence limits (CLs) for the associations of interest. Menstrual and reproductive histories were not associated with risk of BPED of the breast, overall or by histological subtype. Women who had used postmenopausal hormones for 15 years or more had a two-fold increase in risk of BPED of the breast compared to women who had never used postmenopausal hormones (HR = 2.03 95% CL = 1.73, 2.38) and the increase in risk was observed for both BPED of the breast without atypia and for atypical hyperplasia. Furthermore, the risk of BPED of the breast decreased with time since cessation of use so that there was essentially no increase in risk 5 or more years after ending use (HR for stopping >or=5 years earlier = 0.96, 95%CL = 0.79, 1.16; HR for stopping <5 years earlier = 1.32, 95% CL = 1.08,1.61).
月经和生殖史以及绝经后激素使用是乳腺癌公认的风险因素。然而，之前评估这些因素与乳腺良性增生性上皮疾病（BPED）风险（乳腺癌的假定前体）之间关系的研究结果并不一致。为了研究这些关联，我们在参加女性健康倡议随机临床试验的68132名绝经后女性中进行了一项队列研究。对女性进行前瞻性随访，那些报告进行开放性手术活检或粗针活检的女性获取组织学切片用于集中病理检查。在平均7.8年的随访期内，我们识别出1792名患有乳腺BPED的女性。我们使用Cox比例风险模型来估计感兴趣关联的风险比（HRs）和95%置信区间（CLs）。月经和生殖史与乳腺BPED的风险总体上或按组织学亚型均无关联。与从未使用过绝经后激素的女性相比，使用绝经后激素15年或更长时间的女性患乳腺BPED的风险增加了两倍（HR = 2.03，95% CL = 1.73，2.38），并且在无异型性的乳腺BPED和非典型增生中均观察到风险增加。此外，乳腺BPED的风险随着停止使用后的时间而降低，以至于在停止使用5年或更长时间后风险基本没有增加（停止使用≥5年更早的HR = 0.96，95%CL = 0.79，1.16；停止使用<5年更早的HR = 1.32，95% CL = 1.08，1.61）。
