Geneva Cancer Registry, Institute for Social and Preventive Medicine, Geneva University, 55 boulevard de la Cluse, 1205, Geneva, Switzerland.
Breast Cancer Res Treat. 2010 Apr;120(2):519-23. doi: 10.1007/s10549-009-0478-y. Epub 2009 Jul 25.
Hormone replacement therapy (HRT) use declined sharply after mid-2002, when the Women's Health Initiative trial reported an association between breast cancer occurrence and HRT. Hypothesized mechanism behind this association is that HRT promotes growth of pre-existing small tumors, leading to earlier tumor detection. We evaluated the impact of the sudden decline in HRT use on age distribution of breast cancer in Geneva. We included all incident breast cancer cases recorded from 1975 to 2006 at the Geneva cancer registry. We calculated mean annual incidence rates per 100,000 for 2 year periods for three age groups and assessed temporal changes by joinpoint regression. We compared age-specific incidence curves for different periods, reflecting different prevalence rates of HRT use. After increasing constantly between 1986 and 2002 among women aged 50-69 years [annual percent change (APC): +4.4, P < 0.0001], rates declined sharply after 2003 (APC: -6.0; P = 0.0264). Age-specific breast cancer rates changed dramatically with changes in prevalence of HRT use. During low HRT prevalence, breast cancer incidence increased progressively with age, when HRT prevalence was reaching its maximum (1995-2002), higher rates were seen in 60- to 64-year-old women, with a concomitant decrease in risk among elderly. After the sudden decline in HRT use, the incidence peak diminished significantly and incidence increased again with age. Following the abrupt decline in HRT use in Geneva, breast cancer incidence rates among post-menopausal women decreased considerably with striking changes in age-specific incidence rates before, during and after the peak in HRT prevalence.
激素替代疗法（HRT）的使用在 2002 年年中后急剧下降，当时妇女健康倡议试验报告称乳腺癌的发生与 HRT 之间存在关联。这种关联背后的假设机制是 HRT 促进了先前存在的小肿瘤的生长，导致更早的肿瘤检测。我们评估了 HRT 使用的突然下降对日内瓦乳腺癌年龄分布的影响。我们纳入了 1975 年至 2006 年日内瓦癌症登记处记录的所有乳腺癌新发病例。我们计算了三个年龄组每 100,000 人每 2 年的平均年发病率，并通过联合点回归评估了时间变化。我们比较了不同时期不同年龄段的特定发病率曲线，反映了 HRT 使用的不同流行率。在 50-69 岁的女性中，发病率在 1986 年至 2002 年间持续增加（年百分比变化（APC）：+4.4，P < 0.0001），2003 年后急剧下降（APC：-6.0；P = 0.0264）。特定于年龄的乳腺癌发病率随着 HRT 使用流行率的变化而发生显著变化。在 HRT 低流行率期间，随着年龄的增长，乳腺癌发病率逐渐增加，而 HRT 流行率达到最大值（1995-2002 年）时，60-64 岁的女性发病率较高，而老年人群的风险则降低。在 HRT 使用突然下降后，发病率峰值明显减少，随着年龄的增长，发病率再次增加。在日内瓦 HRT 使用急剧下降后，绝经后妇女的乳腺癌发病率显著下降，HRT 流行率达到峰值前后的特定年龄发病率发生了显著变化。
