Vankrunkelsven Patrik, Kellen Eliane, Lousbergh Daniël, Cloes Edith, Op de Beeck Lode, Faes Christel, Bruckers Liesbeth, Mertens Raf, Coebergh Jan W, Van Leeuwen Flora E, Buntinx Frank
Department of General Practice, Katholieke Universiteit Leuven, Leuven, Belgium.
Breast Cancer Res Treat. 2009 Nov;118(2):425-32. doi: 10.1007/s10549-009-0346-9. Epub 2009 Feb 24.
Breast cancer is the most common female cancer in Europe, but its incidence and mortality are rapidly changing across Europe. The early termination of the women's health initiative (WHI) trial, after the detection of an increased breast cancer risk in hormone replacement therapy (HRT) users, was followed by strong declines of HRT use worldwide. We investigated whether the reduction of HRT sales affected breast cancer incidence in the Belgian province Limburg. All women registered in the Limburg Cancer Registry with a diagnosis of invasive breast cancer diagnosed between 1/1/1996 and 31/12/2005 were included in the study. Data on the use of HRT in the population were obtained from the vendors and the social security system. For age-standardization using the direct method, the European standard population was taken. In 2003 and 2004, the breast cancer incidence rate decreased significantly as compared to 2002 for women aged between 50 and 69 years. This sudden drop in the incidence intercepted a markedly increasing trend until 2002, but was followed again by an increase in 2005. Between 2002 and 2006, the sales of HRT (about 75% to women aged 50-69 years) were reduced by 41%. Breast cancer incidence was maximally related to HRT use in the previous year (R(2) = 77%). The decrease of breast cancer incidence in the Belgian province of Limburg may largely be related to the fall of HRT use following the early termination of the WHI trial. This suggests that HRT stimulates the growth of pre-existing, clinically latent tumours that may not otherwise become clinically apparent.
乳腺癌是欧洲最常见的女性癌症，但在欧洲其发病率和死亡率正在迅速变化。在发现激素替代疗法（HRT）使用者患乳腺癌的风险增加后，女性健康倡议（WHI）试验提前终止，随后全球范围内HRT的使用量大幅下降。我们调查了HRT销售量的减少是否影响了比利时林堡省的乳腺癌发病率。纳入研究的对象为1996年1月1日至2005年12月31日期间在林堡癌症登记处登记并被诊断为浸润性乳腺癌的所有女性。人群中HRT使用的数据来自供应商和社会保障系统。采用直接法进行年龄标准化时，使用的是欧洲标准人口。与2002年相比，2003年和2004年50至69岁女性的乳腺癌发病率显著下降。这一发病率的突然下降打断了直至2002年一直明显上升的趋势，但在2005年又再次上升。2002年至2006年间，HRT的销售量（约75%面向50至69岁的女性）减少了41%。乳腺癌发病率与上一年的HRT使用量相关性最大（R² = 77%）。比利时林堡省乳腺癌发病率的下降可能在很大程度上与WHI试验提前终止后HRT使用量的下降有关。这表明HRT会刺激已存在的、临床上潜伏的肿瘤生长，否则这些肿瘤可能不会在临床上显现出来。
