Department of Health and Human Services, Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 6120 Executive Boulevard, Suite 550, Rockville, MD 20852, USA.
Br J Cancer. 2012 Sep 25;107(7):1181-7. doi: 10.1038/bjc.2012.397. Epub 2012 Aug 28.
Women using unopposed estrogens during menopause are at increased risk of ovarian cancer. It is uncertain whether oestrogen plus progestin therapy exerts similar effects.
We evaluated menopausal hormone use and incident ovarian cancer (n=426) in 92601 post-menopausal women enrolled in the National Institutes of Health-AARP (NIH-AARP) Diet and Health Study. Participants were administered questionnaires in 1996-1997 and followed through 2006. Hazard rate ratios (RR) and 95% confidence intervals (CIs) were estimated using Cox regression.
Increased risks were associated with long duration (10+ years) use of unopposed oestrogen (RR 2.15, 95% CI: 1.30-3.57 among women with a hysterectomy) and oestrogen plus progestin (RR 1.68, 95% CI: 1.13-2.49 among women with intact uteri) therapy. Similar risks were associated with progestins that were used sequentially (<15 days progestin per month) (RR 1.60, 95% CI: 1.10-2.33) or continuously (>25 days progestin per month) (RR 1.43, 95% CI: 1.032-2.01; P-value for heterogeneity=0.63).
Our findings suggest that long duration use of both unopposed estrogens and oestrogen plus progestins are associated with increased risks of ovarian cancer, and that risk associated with oestrogen plus progestin use does not vary by regimen (sequential or continuous).
绝经后使用未经拮抗的雌激素的女性患卵巢癌的风险增加。目前尚不确定雌激素加孕激素治疗是否具有类似的作用。
我们评估了 92601 名绝经后女性（来自美国国立卫生研究院-美国退休人员协会（NIH-AARP）饮食与健康研究）在绝经后激素使用与卵巢癌（n=426）发病之间的关系。参与者于 1996-1997 年接受问卷调查，并随访至 2006 年。使用 Cox 回归估计危险率比（RR）和 95%置信区间（CI）。
与长期（10 年以上）使用未经拮抗的雌激素（RR 2.15，95%CI：子宫切除术后妇女为 1.30-3.57）和雌激素加孕激素（RR 1.68，95%CI：子宫完整的妇女为 1.13-2.49）治疗相关的风险增加。类似的风险与孕激素的使用方式有关，即连续（每月孕激素使用<15 天）（RR 1.60，95%CI：1.10-2.33）或连续（每月孕激素使用>25 天）（RR 1.43，95%CI：1.032-2.01；异质性 P 值=0.63）。
我们的研究结果表明，长期使用未经拮抗的雌激素和雌激素加孕激素均与卵巢癌风险增加相关，而雌激素加孕激素治疗的风险与方案（连续或连续）无关。
