San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA.
J Clin Oncol. 2010 Dec 10;28(35):5140-6. doi: 10.1200/JCO.2010.29.5121. Epub 2010 Nov 8.
To assess trends in invasive breast cancer and ductal carcinoma in situ (DCIS) incidence in association with changes in hormone therapy (HT) use in regular mammography screeners.
We included 2,071,814 screening mammography examinations performed between January 1997 and December 2006 on 696,385 women age 40 to 79 years; 9,586 breast cancers were diagnosed within 12 months of a screening examination. We calculated adjusted annual rates (mammogram level) for prevalent HT use, incident invasive breast cancer (overall and by tumor histology and estrogen receptor [ER] status), and incident DCIS.
After a precipitous decrease in HT use in 2002, the incidence of invasive breast cancer decreased significantly in 2002 to 2006 among women age 50 to 69 years (P(trend(2002-2006)) = .005) and 70 to 79 years (P(trend(2002-2006)) = .003) but not in women age 40 to 49 years (P(trend(2002-2006)) = .45). DCIS rates significantly decreased in women age 50 to 69 years after 2002 (P(trend(2002-2006)) = .02). Invasive ductal tumors significantly declined in women age 50 to 69 years and 70 to 79 years in 2002 to 2006. In women age 50 to 69 years, invasive lobular and ER-positive cancer rates declined steadily in 2002 to 2005 (P(trend(2002-2005)) = .02 and .03, respectively), but an elevated rate in 2006 rendered the overall trend nonsignificant (P(trend(2002-2006)) = .89 and .91, respectively).
In parallel to the sharp decline in HT use in women undergoing regular mammography screening, invasive breast cancer rates decreased in women age 50 to 69 and 70 to 79 years after 2002, and DCIS rates decreased in women age 50 to 69 years, consistent with evidence that HT cessation reduces breast cancer risk. However, the decrease in incidence may have started to level off in 2006; this finding has not been uniformly reported in other populations, warranting further investigation.
评估激素疗法（HT）使用变化与常规乳房 X 线筛查中浸润性乳腺癌和导管原位癌（DCIS）发病率变化之间的关系。
我们纳入了 1997 年 1 月至 2006 年 12 月期间在 696385 名 40 至 79 岁女性中进行的 2071814 次筛查性乳房 X 线检查；在筛查后 12 个月内诊断出 9586 例乳腺癌。我们计算了常见 HT 使用、浸润性乳腺癌（整体和肿瘤组织学和雌激素受体 [ER] 状态）和 DCIS 的发生率的调整年度率（乳房 X 线片水平）。
2002 年 HT 使用急剧下降后，2002 年至 2006 年间，50 至 69 岁（P(trend(2002-2006)) =.005）和 70 至 79 岁（P(trend(2002-2006)) =.003）女性的浸润性乳腺癌发病率显著下降，但 40 至 49 岁女性（P(trend(2002-2006)) =.45）的发病率无显著变化。2002 年后，50 至 69 岁女性的 DCIS 发生率显著下降（P(trend(2002-2006)) =.02）。2002 年至 2006 年间，50 至 69 岁和 70 至 79 岁女性的浸润性导管肿瘤显著下降。在 50 至 69 岁的女性中，浸润性小叶癌和 ER 阳性癌的发病率在 2002 年至 2005 年期间持续下降（P(trend(2002-2005)) =.02 和.03），但 2006 年的发病率升高使整体趋势无统计学意义（P(trend(2002-2006)) =.89 和.91）。
与接受常规乳房 X 线筛查的女性中 HT 使用急剧下降的情况一致，2002 年后，50 至 69 岁和 70 至 79 岁女性的浸润性乳腺癌发病率下降，50 至 69 岁女性的 DCIS 发病率下降，这与 HT 停止使用可降低乳腺癌风险的证据一致。然而，发病率的下降可能在 2006 年开始趋于平稳；这一发现尚未在其他人群中得到一致报告，需要进一步研究。
