Eliassen A Heather, Hankinson Susan E
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
Adv Exp Med Biol. 2008;630:148-65.
Multiple lines of evidence support a central role of hormones in the etiology of breast, endometrial and ovarian cancers. Evidence of an association between circulating hormones and these cancers varies by both hormone and cancer site, with the most consistent associations observed for sex steroid hormones and breast cancer risk among postmenopausal women. Recently, evidence has begun to accumulate suggesting an important role for endogenous hormones in premenopausal breast cancer, endometrial cancer and possibly ovarian cancer. In this chapter, prospective epidemiologic studies, where endogenous hormones are measured in study subjects prior to disease diagnosis, are summarized. Overall, a strong positive association between breast cancer risk and circulating levels of both estrogens and testosterone has now been well confirmed among postmenopausal women; women with hormone levels in the top 20% of the distribution (versus bottom 20%) have a two-to-three-fold higher risk of breast cancer. Evidence amongpremenopausal women is more limited, though increased risk associated with higher levels of testosterone is consistent. Evidence to date of hormonal associations for endometrial cancer is limited, though a strong association with sex steroid hormones is suggested. Studies of ovarian cancer have been few and small with no consistent associations observed with endogenous hormones. Clearly more evaluation is needed to confirm the role of endogenous hormones in premenopausal breast cancer, endometrial cancer and ovarian cancer.
多条证据支持激素在乳腺癌、子宫内膜癌和卵巢癌病因学中起核心作用。循环激素与这些癌症之间关联的证据因激素和癌症部位而异，绝经后女性中性类固醇激素与乳腺癌风险之间的关联最为一致。最近，有证据开始积累，表明内源性激素在绝经前乳腺癌、子宫内膜癌以及可能在卵巢癌中起重要作用。在本章中，总结了前瞻性流行病学研究，这些研究在疾病诊断前对研究对象的内源性激素进行了测量。总体而言，绝经后女性中乳腺癌风险与雌激素和睾酮的循环水平之间的强正相关现已得到充分证实；激素水平处于分布前20%（相对于后20%）的女性患乳腺癌的风险高出两到三倍。绝经前女性中的证据较为有限，不过睾酮水平较高与风险增加之间的关联是一致的。迄今为止，关于子宫内膜癌激素关联的证据有限，不过提示与性类固醇激素有强关联。卵巢癌的研究较少且规模较小，未观察到与内源性激素有一致的关联。显然，需要更多评估来证实内源性激素在绝经前乳腺癌、子宫内膜癌和卵巢癌中的作用。
