Rohan Thomas E, Negassa Abdissa, Chlebowski Rowan T, Ceria-Ulep Clementina D, Cochrane Barbara B, Lane Dorothy S, Ginsberg Mindy, Wassertheil-Smoller Sylvia, Page David L
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
Breast Cancer Res Treat. 2009 Jul;116(2):339-50. doi: 10.1007/s10549-008-0213-0. Epub 2008 Oct 14.
Experimental evidence provides strong support for anti-carcinogenic effects of calcium and vitamin D with respect to breast cancer. Observational epidemiologic data also provide some support for inverse associations with risk. We tested the effect of calcium plus vitamin D supplementation on risk of benign proliferative breast disease, a condition which is associated with increased risk of breast cancer. We used the Women's Health Initiative randomized controlled trial. The 36,282 participants were randomized either to 500 mg of elemental calcium as calcium carbonate plus 200 IU of vitamin D(3) (GlaxoSmithKline) twice daily (n = 18,176) or to placebo (n = 18,106). Regular mammograms and clinical breast exams were performed. We identified women who had had a biopsy for benign breast disease and subjected histologic sections from the biopsies to standardized review. After an average follow-up period of 6.8 years, 915 incident cases of benign proliferative breast disease had been ascertained, with 450 in the intervention group and 465 in the placebo group. Calcium plus vitamin D supplementation was not associated with altered risk of benign proliferative breast disease overall (hazard ratio = 0.99, 95% confidence interval = 0.86-1.13), or by histologic subtype. Risk varied significantly by levels of age at baseline, but not by levels of other variables. Daily use of 1,000 mg of elemental calcium as calcium carbonate plus 400 IU of vitamin D(3) for almost 7 years by postmenopausal women did not alter the overall risk of benign proliferative breast disease.
实验证据为钙和维生素D对乳腺癌的抗癌作用提供了有力支持。观察性流行病学数据也为其与风险的负相关提供了一些支持。我们测试了补充钙加维生素D对良性增生性乳腺疾病风险的影响，这种疾病与乳腺癌风险增加有关。我们使用了妇女健康倡议随机对照试验。36282名参与者被随机分为两组，一组每天两次服用500毫克碳酸钙形式的元素钙加200国际单位维生素D（3）（葛兰素史克公司生产）（n = 18176），另一组服用安慰剂（n = 18106）。定期进行乳房X光检查和临床乳腺检查。我们确定了那些因良性乳腺疾病进行活检的女性，并对活检组织切片进行标准化检查。经过平均6.8年的随访，共确诊915例良性增生性乳腺疾病新发病例，其中干预组450例，安慰剂组465例。总体而言，补充钙加维生素D与良性增生性乳腺疾病风险的改变无关（风险比=0.99，95%置信区间=0.86 - 1.13），按组织学亚型分析也是如此。风险因基线年龄水平差异显著，但不受其他变量水平影响。绝经后女性每天服用1000毫克碳酸钙形式的元素钙加400国际单位维生素D（3）近7年，并未改变良性增生性乳腺疾病的总体风险。
