当前维生素 D 补充剂与绝经激素治疗使用对乳腺癌风险的相互作用：E3N 队列的证据。

Interaction between current vitamin D supplementation and menopausal hormone therapy use on breast cancer risk: evidence from the E3N cohort.

机构信息

Inserm, Centre for Research in Epidemiology and Population Health, Nutrition, Hormones and Women's Health Team, Villejuif Cedex, France; Université Paris-Sud, Villejuif Cedex, France; and Gustave Roussy, Villejuif Cedex, France.

出版信息

Am J Clin Nutr. 2015 Oct;102(4):966-73. doi: 10.3945/ajcn.114.104323. Epub 2015 Sep 9.

DOI:10.3945/ajcn.114.104323

PMID:26354532

Abstract

BACKGROUND

Experimental studies suggest protective effects of vitamin D on breast carcinogenesis, particularly on estrogen receptor-positive tumors. Epidemiologic data are less conclusive.

OBJECTIVE

Our objective was to investigate the association between postmenopausal breast cancer risk and current or past vitamin D supplementation overall and according to the use of menopausal hormone therapy (MHT).

DESIGN

Between 1995 and 2008, 2482 invasive breast cancer cases were diagnosed among 57,403 postmenopausal women from the E3N prospective cohort during 581,085 person-years. Vitamin D supplementation was assessed from biennially self-administered questionnaires sent in 1995, 2000, 2002, and 2005 and from medico-administrative data on drug reimbursements since 2004. Multivariable HRs for primary invasive breast cancer and 95% CIs were estimated by using Cox models.

RESULTS

A decreased postmenopausal breast cancer risk was associated with current (HR: 0.82; 95% CI: 0.69, 0.97) but not past (HR: 1.10; 95% CI: 0.92, 1.31) vitamin D supplementation (P-homogeneity = 0.02). The association with current vitamin D supplementation differed according to MHT use: ever users (HR: 0.74; 95% CI: 0.60, 0.90) and never users (HR: 1.13; 95% CI: 0.89, 1.56); P-homogeneity = 0.02.

CONCLUSIONS

In this observational study, current vitamin D supplementation, mostly taken daily and combined with calcium, was associated with a decreased postmenopausal breast cancer risk in MHT users. These findings should be confirmed before considering vitamin D supplementation to partly balance the MHT-associated increased breast cancer risk.

摘要

背景

实验研究表明，维生素 D 对乳腺癌发生具有保护作用，尤其对雌激素受体阳性肿瘤。但流行病学数据的结论尚不明确。

目的

本研究旨在调查绝经后女性乳腺癌风险与维生素 D 补充剂的使用（包括当前使用和既往使用）之间的相关性，以及维生素 D 补充剂的使用与是否接受激素替代疗法（HRT）之间的相关性。

设计

E3N 前瞻性队列研究纳入了 57403 名绝经后女性，随访 581085 人年，共诊断出 2482 例浸润性乳腺癌病例。维生素 D 补充剂的使用情况通过 1995 年、2000 年、2002 年和 2005 年每两年一次的自我报告问卷以及 2004 年以来的药物报销医疗记录进行评估。使用 Cox 模型估计主要浸润性乳腺癌的多变量 HR 和 95%CI。

结果

当前使用维生素 D 补充剂与绝经后乳腺癌风险降低相关（HR：0.82；95%CI：0.69，0.97），但既往使用维生素 D 补充剂与绝经后乳腺癌风险无关（HR：1.10；95%CI：0.92，1.31）（P 趋势=0.02）。当前维生素 D 补充剂与 HRT 使用之间的相关性存在差异：HRT 使用者（HR：0.74；95%CI：0.60，0.90）和非使用者（HR：1.13；95%CI：0.89，1.56）（P 趋势=0.02）。