Mikkola Tomi S, Savolainen-Peltonen Hanna, Tuomikoski Pauliina, Hoti Fabian, Vattulainen Pia, Gissler Mika, Ylikorkala Olavi
1Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland 2Folkhälsan Research Center, Biomedicum, Helsinki, Finland 3EPID Research Oy, Espoo, Finland 4Information Services Department, National Institute for Health and Welfare, Helsinki, Finland.
Menopause. 2016 Nov;23(11):1199-1203. doi: 10.1097/GME.0000000000000698.
Data are controversial on the impact of postmenopausal hormone therapy (HT) on breast cancer mortality. We analyzed nationwide Finnish data on breast cancer mortality risk in women using HT consisting of estradiol-only therapy (ET) or estrogen-progestogen therapy (EPT).
In total, 489,105 women using HT in 1994 to 2009, traced from the nationwide reimbursement register, were followed from the HT initiation (3.3 million cumulative exposure years) to breast cancer death (n = 1,578 women). The observed deaths were compared with those in the age-standardized background population.
The breast cancer mortality risk was reduced in all HT users with exposure for at most 5 years (standardized mortality ratio 0.56; CI 0.52-0.60), more than 5 to 10 years (0.46; 0.41-0.51), or more than 10 years (0.62; 0.56-0.68). A significantly larger risk reduction was detected in the 50 to 59 years age group (0.33; 0.29-0.37) compared with 60 to 69 (0.64; 0.59-0.70) or 70 to 79 (0.78; 0.69-0.87) years age groups. The death risk reductions in ET users tended to be larger in all age groups compared with EPT users, with a significant difference only in the 70 to 79 years age group (0.66; 0.57-0.76 vs 0.88; 0.77-1.00). The age at HT initiation, regardless whether ET or EPT, showed no association with breast cancer mortality.
In the Finnish unselected population, breast cancer is fatal in 1 of 10 patients. Our data imply that this risk is prevalent in 1 of 20 patients with history of HT use. This is an important message for women considering or already using HT.
绝经后激素治疗（HT）对乳腺癌死亡率的影响，数据存在争议。我们分析了芬兰全国范围内使用仅含雌二醇治疗（ET）或雌激素 - 孕激素治疗（EPT）的HT女性乳腺癌死亡风险的数据。
从全国报销登记册中追踪到1994年至2009年期间总共489,105名使用HT的女性，从开始使用HT（累积暴露330万患者年）至乳腺癌死亡（n = 1,578名女性）进行随访。将观察到的死亡人数与年龄标准化的背景人群中的死亡人数进行比较。
所有使用HT且暴露时间最多5年的使用者中，乳腺癌死亡率风险降低（标准化死亡率0.56；95%置信区间0.52 - 0.60），暴露5年以上至10年（0.46；0.41 - 0.51），或暴露10年以上（0.62；0.56 - 0.68）。与60至69岁（0.64；0.59 - 0.70）或70至79岁（0.78；0.69 - （此处原文可能有误，推测为0.87）0.87）年龄组相比，50至59岁年龄组的风险降低更为显著（0.33；0.29 - 0.37）。与EPT使用者相比，所有年龄组中ET使用者的死亡风险降低趋势更大，仅在70至79岁年龄组存在显著差异（0.66；0.57 - 0.76对比0.88；0.77 - 1.00）。开始使用HT的年龄，无论使用ET还是EPT，均与乳腺癌死亡率无关。
在芬兰未经过筛选的人群中，每10例乳腺癌患者中有1例死亡。我们的数据表明，在有HT使用史的患者中，这一风险在每20例患者中出现1例。对于考虑或已经在使用HT的女性而言，这是一个重要信息。
