Chen Fang-Ping
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Chang Gung Med J. 2009 Mar-Apr;32(2):140-7.
Risks from hormone use among postmenopausal women will be particularly important in the future, given the worldwide increase in the number of older women in the population. Recent randomized clinical trials and epidemiological studies have reported various opinions on the association between the risk of breast cancer and postmenopausal hormone therapy (HT), especially the differences between therapy with unopposed estrogen and combined estrogen-progestin. The currently available data do not provide sufficient evidence to prove a causal association between postmenopausal HT and breast cancer. However, a possible risk of breast cancer associated with long-term HT usage should not be ignored, given that the degree of association between breast cancer and postmenopausal HT remains controversial. Unanswered questions include whether HT has a positive impact on breast cancer, and whether different types and routes of estrogen and progestogens, as well as the duration and cessation of HT use have different impacts on this disorder. Despite this, HT is still the most effective method of relieving climacteric symptoms for many postmenopausal women. Since the effect of HT on breast cancer risk may be related to individual susceptibility, we recommend close follow-up through mammography and/or breast sonography and an even more detailed evaluation of the potential of exogenous hormones inducing epithelial hyperplasia in those with increased breast density or any other high risk factors.
鉴于全球老年女性人口数量的增加，绝经后女性使用激素的风险在未来将尤为重要。近期的随机临床试验和流行病学研究就乳腺癌风险与绝经后激素治疗（HT）之间的关联，尤其是单纯雌激素治疗与雌激素 - 孕激素联合治疗之间的差异，报告了各种观点。目前可得的数据并未提供充分证据来证明绝经后HT与乳腺癌之间存在因果关联。然而，考虑到乳腺癌与绝经后HT之间的关联程度仍存在争议，长期使用HT可能存在的乳腺癌风险不应被忽视。尚未解答的问题包括HT对乳腺癌是否有积极影响，以及雌激素和孕激素的不同类型与给药途径，以及HT使用的持续时间和停药情况对这种疾病是否有不同影响。尽管如此，对于许多绝经后女性而言，HT仍然是缓解更年期症状最有效的方法。由于HT对乳腺癌风险的影响可能与个体易感性有关，我们建议通过乳房X光检查和/或乳腺超声进行密切随访，并对乳腺密度增加或有任何其他高危因素的人群中外源激素诱导上皮增生的可能性进行更详细的评估。
