National Cancer Institute, Bethesda, MD, MD 20852, USA.
J Clin Oncol. 2013 Jun 10;31(17):2146-51. doi: 10.1200/JCO.2012.45.5758. Epub 2013 May 6.
After a report from the Women's Health Initiative (WHI) in 2002, a precipitous decline in menopausal hormonal therapy (MHT) use in the United States was linked to a decline in breast cancer incidence rates. Given that MHT use is also associated with increased ovarian cancer risk, we tested whether ovarian cancer incidence rates changed after 2002.
Using the North American Association of Central Cancer Registries database (1995 to 2008; N = 171,142 incident ovarian cancers), we applied standard analytic approaches and age-period-cohort (APC) models to estimate ovarian cancer incidence rate changes before (1995 to 2002) and after (2003 to 2008) the WHI report.
Among women age ≥ 50 years, age-standardized ovarian cancer incidence declined by 0.8% per year (95% CI, -1.8% to -0.5% per year) before the WHI announcement; after the WHI report, the rate declined by 2.4% per year (95% CI, -2.5% to -2.2% per year). APC models confirmed an accelerated decline in ovarian cancer incidence after the WHI report, adjusted for age and birth cohort effects. This sudden change was notable among women most likely to have used MHT (ie, women age 50 to 69 years, white women, and residents of regions with highest MHT prescription frequency). The largest changes were found for the endometrioid histologic subtype.
After a marked reduction in MHT use around 2002, ovarian cancer incidence rates demonstrated an accelerated decline, with the largest changes for endometrioid carcinomas. This strong temporal association, although not proving a causal role of hormones in ovarian carcinogenesis, suggests that future analytic research supporting cancer control efforts should clarify the role of hormonal exposures on the development and behavior of subtypes of ovarian cancer.
2002 年妇女健康倡议（WHI）报告发布后，美国更年期激素疗法（MHT）的使用急剧下降，与乳腺癌发病率的下降有关。鉴于 MHT 的使用也与卵巢癌风险的增加有关，我们检测了 2002 年后卵巢癌的发病率是否发生了变化。
我们使用北美癌症登记协会数据库（1995 年至 2008 年；N=171142 例卵巢癌发病），应用标准分析方法和年龄-时期-队列（APC）模型，估计 WHI 报告前后（1995 年至 2002 年和 2003 年至 2008 年）卵巢癌发病率的变化。
在≥50 岁的女性中，WHI 公告前，年龄标准化卵巢癌发病率每年下降 0.8%（95%CI，每年-1.8%至-0.5%）；WHI 报告后，发病率每年下降 2.4%（95%CI，每年-2.5%至-2.2%）。APC 模型证实，WHI 报告后，卵巢癌发病率加速下降，调整了年龄和出生队列效应。在最有可能使用 MHT 的女性（即 50 至 69 岁的女性、白人女性和 MHT 处方频率最高的地区的居民）中，这种突然的变化尤为明显。最大的变化发生在子宫内膜样组织学亚型。
在 2002 年左右 MHT 使用率显著下降后，卵巢癌发病率显示出加速下降的趋势，其中子宫内膜样癌的变化最大。这种强烈的时间关联，尽管不能证明激素在卵巢癌发生中的因果作用，但表明未来支持癌症控制努力的分析研究应阐明激素暴露对卵巢癌各亚型的发展和行为的作用。
