Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA.
Int J Cancer. 2010 Dec 15;127(12):2928-35. doi: 10.1002/ijc.25515.
Ovarian cancer has been associated in epidemiologic studies with postmenopausal hormone use. Whether associations differ by hormone regimen, current status or duration of use is unclear. We examined epithelial ovarian cancer incidence in relation to unopposed estrogen (E-only) and estrogen plus progestin (E + P) among 54,436 postmenopausal women of the Cancer Prevention Study II Nutrition Cohort, a US cohort prospectively followed for cancer incidence since 1992. Demographic, medical, reproductive and lifestyle information was collected at enrollment and updated throughout follow-up via self-administered questionnaire. Extended Cox models were used to estimate age- and multivariate-adjusted relative risk (RR) of ovarian cancer according to hormone regimen, current status and duration of use. During 15 years of follow-up, 297 incident cases were identified. Relative to "never" use of hormones, current E-only use was associated with a twofold higher risk [RR 2.07, 95% confidence interval (CI) 1.50-2.85]; each 5-year increment of use was associated with a 25% higher risk (RR 1.25, 95% CI 1.15-1.36); ≥ 20 years of use was associated with a near threefold higher risk (RR 2.89; 95% CI 1.71-4.87; trend p = 0.01). Past E-only use was not significantly associated with ovarian cancer, although a modest increase in risk per each 5-year increment of use was suggested (RR 1.14, 95% CI 0.92-1.41). Neither current nor former E + P use was associated with ovarian cancer risk (RR 1.08, 95% CI 0.86-1.35; RR 1.08, 95% CI 0.68-1.71, respectively, per 5-year increment). These findings suggest that progestins may mitigate some of the detrimental effects of estrogen on the ovarian epithelium.
卵巢癌在流行病学研究中与绝经后激素使用有关。激素方案、当前使用状态或使用持续时间是否存在差异尚不清楚。我们研究了 54436 名绝经后妇女中上皮性卵巢癌的发病率与单纯雌激素（E 仅）和雌激素加孕激素（E + P）之间的关系，这些妇女来自美国队列癌症预防研究 II 营养队列，自 1992 年以来一直前瞻性地随访癌症发病率。在入组时收集了人口统计学、医学、生殖和生活方式信息，并通过自我管理问卷在随访过程中进行更新。使用扩展 Cox 模型根据激素方案、当前使用状态和使用持续时间来估计年龄和多变量调整后的相对风险（RR）。在 15 年的随访期间，发现了 297 例病例。与“从不”使用激素相比，当前 E 仅使用与风险增加两倍相关[RR 2.07，95%置信区间（CI）1.50-2.85]；每增加 5 年使用与风险增加 25%相关（RR 1.25，95% CI 1.15-1.36）；≥20 年的使用与风险增加近三倍相关（RR 2.89；95% CI 1.71-4.87；趋势 p = 0.01）。过去的 E 仅使用与卵巢癌无显著相关性，尽管每增加 5 年使用风险略有增加（RR 1.14，95% CI 0.92-1.41）。当前或既往 E + P 使用均与卵巢癌风险无关（RR 1.08，95% CI 0.86-1.35；RR 1.08，95% CI 0.68-1.71，每增加 5 年使用一次）。这些发现表明孕激素可能减轻雌激素对卵巢上皮的一些不良影响。
