Unit of Diet, Genes, and Environment, Danish Cancer Society Research Center, 49 Strandboulevarden, 2100, Copenhagen, Denmark.
Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark.
Horm Cancer. 2018 Aug;9(4):254-264. doi: 10.1007/s12672-018-0338-5. Epub 2018 Jun 14.
The past decades have seen contradictory research results on the health benefits and risks of menopausal hormone therapy (HT). In particular, long-term associations with overall cancer incidence and the potential interplay with other lifestyle factors remain undetermined. In a population-based prospective cohort, 29,152 women aged 50-64 years at entry (1993-1997) were followed through 2013 for incidence of cancer (99% complete follow-up). Cox' proportional hazards models were used to estimate cancer incidence according to baseline HT alone and in combination with lifestyle factors including alcohol intake, BMI, physical activity, diet, and smoking. Among 5484 women diagnosed with cancer, baseline HT was associated with an overall higher risk of cancer (HR 1.28; 95%CI, 1.21-1.36)-in particular, a higher risk of breast (HR 1.77; 95%CI, 1.61-1.95), ovarian (HR 1.68; 95%CI, 1.26-2.26), and endometrial (HR 1.86; 95%CI, 1.45-2.37) cancer. Combination with other lifestyle risk factors largely displayed additive associations. The risk of colorectal cancer was significantly lower (HR 0.79; 95%CI, 0.66-0.95). However, in the interaction analysis, only "healthy" subgroups of women using HT had a lower risk of colorectal cancer. With an overall higher risk of cancer among women on HT, this study underlined the importance of considering all female cancer risks in menopausal treatment guidelines. The largely additive associations between HT and the investigated lifestyle factors support the notion that high levels of hormones in itself play an important etiological role in female reproductive cancers, whereas the possible protective impact in colorectal cancer might be limited to women with an otherwise healthy lifestyle.
过去几十年的研究结果对绝经激素治疗（HT）的健康益处和风险存在矛盾。特别是，长期与整体癌症发病率的关联以及与其他生活方式因素的潜在相互作用仍未确定。在一项基于人群的前瞻性队列研究中，29152 名年龄在 50-64 岁的女性（1993-1997 年入组）在 2013 年之前被跟踪调查癌症的发病率（99%的完全随访）。使用 Cox 比例风险模型根据基线 HT 以及与生活方式因素（包括饮酒、BMI、身体活动、饮食和吸烟）的组合来估计癌症的发病率。在 5484 名被诊断患有癌症的女性中，基线 HT 与整体癌症风险升高相关（HR 1.28；95%CI，1.21-1.36）-特别是乳腺癌（HR 1.77；95%CI，1.61-1.95）、卵巢癌（HR 1.68；95%CI，1.26-2.26）和子宫内膜癌（HR 1.86；95%CI，1.45-2.37）的风险更高。与其他生活方式风险因素的组合主要显示出相加的关联。结直肠癌的风险显著降低（HR 0.79；95%CI，0.66-0.95）。然而，在交互分析中，只有使用 HT 的“健康”女性亚组结直肠癌的风险较低。由于接受 HT 的女性整体癌症风险较高，本研究强调了在绝经治疗指南中考虑所有女性癌症风险的重要性。HT 与所研究的生活方式因素之间的大部分相加关联支持这样一种观点，即高水平的激素本身在女性生殖系统癌症的病因学中发挥着重要作用，而在结直肠癌中可能的保护作用可能仅限于生活方式健康的女性。
