Crandall Carolyn J, Aragaki Aaron K, Chlebowski Rowan T, McTiernan Anne, Anderson Garnet, Hendrix Susan L, Cochrane Barbara B, Kuller Lewis H, Cauley Jane A
Department of Medicine, David Geffen School of Medicine at University of California, UCLA Medicine/GIM, Los Angeles, CA 90024, USA.
Arch Intern Med. 2009 Oct 12;169(18):1684-91. doi: 10.1001/archinternmed.2009.303.
Estrogen plus progestin therapy increases breast cancer incidence and breast tenderness. Whether breast tenderness during estrogen plus progestin therapy is associated with breast cancer risk is uncertain.
We analyzed data from the Women's Health Initiative Estrogen + Progestin Trial, which randomized postmenopausal women with an intact uterus to receive daily conjugated equine estrogens, 0.625 mg, plus medroxyprogesterone acetate, 2.5 mg (n = 8506), or placebo (n = 8102). At baseline and annually, participants underwent mammography and clinical breast examination. Self-reported breast tenderness was assessed at baseline and at 12 months. The incidence of invasive breast cancer was confirmed by medical record review (mean follow-up of 5.6 years).
Of women without baseline breast tenderness (n = 14,538), significantly more assigned to receive conjugated equine estrogens plus medroxyprogesterone vs placebo experienced new-onset breast tenderness after 12 months (36.1% vs 11.8%, P < .001). Of women in the conjugated equine estrogens plus medroxyprogesterone group, breast cancer risk was significantly higher in those with new-onset breast tenderness compared with those without (hazard ratio, 1.48; 95% confidence interval, 1.08-2.03; P = .02). In the placebo group, breast cancer risk was not significantly associated with new-onset breast tenderness (P = .97).
New-onset breast tenderness during conjugated equine estrogens plus medroxyprogesterone therapy was associated with increased breast cancer risk. The sensitivity and specificity of the association between breast tenderness and breast cancer were similar in magnitude to those of the Gail model. Trial Registration clinicaltrials.gov Identifier: NCT00000611.
雌激素加孕激素疗法会增加乳腺癌发病率和乳房压痛。雌激素加孕激素治疗期间的乳房压痛是否与乳腺癌风险相关尚不确定。
我们分析了妇女健康倡议雌激素加孕激素试验的数据，该试验将有完整子宫的绝经后妇女随机分为两组，一组每日接受0.625毫克结合马雌激素加2.5毫克醋酸甲羟孕酮（n = 8506），另一组接受安慰剂（n = 8102）。在基线和每年，参与者接受乳房X线摄影和临床乳房检查。在基线和12个月时评估自我报告的乳房压痛情况。通过病历审查确认浸润性乳腺癌的发病率（平均随访5.6年）。
在无基线乳房压痛的女性（n = 14,538）中，接受结合马雌激素加醋酸甲羟孕酮治疗的女性在12个月后出现新发乳房压痛的比例显著高于接受安慰剂的女性（36.1%对11.8%，P <.001）。在结合马雌激素加醋酸甲羟孕酮组中，出现新发乳房压痛的女性患乳腺癌的风险显著高于未出现者（风险比，1.48；95%置信区间，1.08 - 2.03；P =.02）。在安慰剂组中，新发乳房压痛与乳腺癌风险无显著关联（P =.97）。
结合马雌激素加醋酸甲羟孕酮治疗期间出现的新发乳房压痛与乳腺癌风险增加相关。乳房压痛与乳腺癌之间关联的敏感性和特异性在程度上与盖尔模型相似。试验注册 clinicaltrials.gov标识符：NCT00000611。
