Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts.
Slone Epidemiology Center, Boston University, Boston, Massachusetts.
Cancer Epidemiol Biomarkers Prev. 2018 May;27(5):558-565. doi: 10.1158/1055-9965.EPI-17-0722. Epub 2018 Feb 23.
Although endometrial cancer risk differs among white and black women, few data on its associations with exogenous hormone use in the latter group are available. Studies have reported lower endometrial cancer risk among users of oral contraceptives (OCs), but higher risk among users of estrogen-only female menopausal hormones (FMHs). Evidence for the risk among estrogen plus progestin FMHs users is equivocal. We followed 47,555 Black Women's Health Study participants with an intact uterus from 1995 through 2013. Data on exogenous hormone use, covariates, and endometrial cancer were obtained biennially. Self-reported incident cases of endometrial cancer were confirmed by medical records or cancer registries whenever possible. We estimated incidence rate ratios (IRRs) and 95% confidence intervals (CIs) using Cox proportional hazards regression. We observed 300 endometrial cancer cases during 689,546 person-years of follow-up. Compared with never use, ≥10 years' duration of OC use was associated with lower risk (multivariable IRR = 0.45, 95% CI, 0.27-0.74), but risk was higher among current users of estrogen-only (IRR = 3.78, 95% CI, 1.69-8.43) and estrogen plus progestin FMH (IRR = 1.55, 95% CI, 0.78-3.11). Risk was not increased among former users of estrogen-only (IRR = 0.87, 95% CI, 0.44-1.72) or estrogen plus progestin FMH (IRR = 0.63, 95% CI, 0.36-1.09). Current use of estrogen-only and estrogen plus progestin FMH was associated with increased risk of endometrial cancer. Risk appeared lower among former users of estrogen plus progestin FMH. Long-term OC use was associated with reduced risk. Our results are generally consistent with those among white women. .
尽管子宫内膜癌的风险在白人和黑人女性中有所不同，但关于后者群体中外源性激素使用与子宫内膜癌的关系的数据很少。研究报告称，口服避孕药（OC）使用者的子宫内膜癌风险较低，但仅使用雌激素的女性绝经激素（FMH）使用者的风险较高。对于雌激素加孕激素 FMH 使用者的风险证据尚无定论。我们对 1995 年至 2013 年间有完整子宫的 47555 名黑人女性健康研究参与者进行了随访。每两年收集一次外源性激素使用、协变量和子宫内膜癌的数据。尽可能通过病历或癌症登记处确认自我报告的子宫内膜癌新发病例。我们使用 Cox 比例风险回归估计发病率比（IRR）和 95%置信区间（CI）。我们在 689546 人年的随访中观察到 300 例子宫内膜癌病例。与从不使用相比，≥10 年 OC 使用与较低的风险相关（多变量 IRR=0.45，95%CI，0.27-0.74），但当前仅使用雌激素（IRR=3.78，95%CI，1.69-8.43）和雌激素加孕激素 FMH（IRR=1.55，95%CI，0.78-3.11）的使用者风险更高。以前仅使用雌激素（IRR=0.87，95%CI，0.44-1.72）或雌激素加孕激素 FMH（IRR=0.63，95%CI，0.36-1.09）的使用者风险并未增加。当前仅使用雌激素和雌激素加孕激素 FMH 与子宫内膜癌风险增加相关。以前使用雌激素加孕激素 FMH 的风险较低。长期使用 OC 与降低风险相关。我们的结果与白人女性的结果大致一致。
