Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles UCLA Medicine/GIM, 911 Broxton Avenue, 1st Floor, Los Angeles, CA 90024, USA.
Breast Cancer Res Treat. 2012 Feb;132(1):275-85. doi: 10.1007/s10549-011-1848-9. Epub 2011 Nov 1.
The associations between breast tenderness during use of conjugated equine estrogen (CEE) therapy with or without medroxyprogesterone (MPA) therapy and subsequent breast cancer risk are unknown. We analyzed data from the Women's Health Initiative Estrogen plus Progestin (N = 16,608, 5.6 years intervention) and estrogen-alone (N = 10,739, 6.8 years intervention) clinical trials until trial close-out (Spring 2005). At baseline and annually, participants underwent mammography and clinical breast exam. Self-reported breast tenderness was assessed at baseline and 12 months. Invasive breast cancer was confirmed by medical record review. The risk of new-onset breast tenderness after 12 months was significantly higher among women assigned to active therapy than placebo (CEE-alone vs. placebo risk ratio [RR] 2.15, 95% confidence interval [CI] 1.97-2.35; CEE + MPA vs. placebo RR 3.07, 95% CI 2.85-3.30). CEE + MPA doubled the risk of invasive breast cancer among women with baseline breast tenderness (hazard ratio [HR] 2.16, 95% CI 1.29-3.74), but had a smaller effect among women without baseline breast tenderness (HR 1.17; 95% CI 0.97-1.41). New-onset breast tenderness was associated with a higher risk of breast cancer among women assigned to CEE + MPA (HR 1.33, 95% CI 1.02-1.72, P = 0.03), but not among women assigned to CEE-alone (HR 0.98, 95% CI 0.62-1.53). New-onset breast tenderness during use of CEE + MPA was associated with increased subsequent breast cancer risk. The association of CEE + MPA therapy with increased breast cancer risk was especially pronounced among women with baseline breast tenderness.
使用结合雌激素（CEE）联合或不联合醋酸甲羟孕酮（MPA）治疗期间乳房触痛与随后乳腺癌风险之间的关系尚不清楚。我们分析了来自妇女健康倡议雌激素加孕激素（N=16608，干预 5.6 年）和雌激素单独治疗（N=10739，干预 6.8 年）临床试验的数据，直至试验结束（2005 年春季）。在基线和每年，参与者都接受了乳房 X 线照相术和临床乳房检查。自我报告的乳房触痛在基线和 12 个月时进行评估。新发生的浸润性乳腺癌通过病历审查确认。与安慰剂相比，接受活性治疗的女性在 12 个月后发生新的乳房触痛的风险显著更高（CEE 单独治疗与安慰剂风险比 [RR]2.15，95%置信区间 [CI]1.97-2.35；CEE+MPA 与安慰剂 RR3.07，95%CI2.85-3.30）。CEE+MPA 使基线时存在乳房触痛的女性发生浸润性乳腺癌的风险增加了一倍（风险比 [HR]2.16，95%CI1.29-3.74），但在基线时无乳房触痛的女性中影响较小（HR1.17；95%CI0.97-1.41）。新发乳房触痛与接受 CEE+MPA 治疗的女性乳腺癌风险增加相关（HR1.33，95%CI1.02-1.72，P=0.03），但与接受 CEE 单独治疗的女性无关（HR0.98，95%CI0.62-1.53）。在接受 CEE+MPA 治疗期间新发乳房触痛与随后的乳腺癌风险增加相关。CEE+MPA 治疗与乳腺癌风险增加之间的关联在基线时存在乳房触痛的女性中尤为明显。
