Department of Bowel Cancer Screening, Cancer Registry of Norway, Oslo University Hospital, Oslo, Norway.
Norwegian National Advisory Unit for Women's Health, Women's Clinic, Oslo University Hospital, Oslo, Norway.
Cancer Epidemiol Biomarkers Prev. 2019 Nov;28(11):1857-1860. doi: 10.1158/1055-9965.EPI-19-0554. Epub 2019 Aug 27.
The association between use of menopausal hormone therapy and risk of cutaneous melanoma is highly debated. We investigated the issue in a Finnish nationwide cohort of women ages 50 years or older.
All women who had purchased hormone therapy between 1994 and 2007 were identified from the national Medical Reimbursement Registry and linked to the Finnish Cancer Registry. We calculated standardized incidence ratios (SIR) to compare incidence of cutaneous melanoma among hormone therapy users with that of the general population.
During a mean follow-up of 15.6 years, 1,695 incident cutaneous melanoma cases were identified among 293,570 women who had used hormone therapy for at least 6 months. The SIRs for women who used unopposed estrogen therapy and combined estrogen-progestin therapy (EPT) for 6 to 59 months were 1.20 [95% confidence interval (CI), 1.06-1.35] and 1.00 (95% CI, 0.87-1.14; = 0.04). The SIRs for women who used estrogen therapy and EPT for at least 60 months were 1.37 (95% CI, 1.22-1.52) and 1.23 (95% CI, 1.13-1.34; = 0.15). We did not find significant differences between oral and transdermal administrations, nor between doses of estrogens.
Use of hormone therapy, especially estrogen therapy, was associated with an increased risk of cutaneous melanoma. EPT use of less than 5 years was not associated with an increased risk of cutaneous melanoma.
Our results add to the growing body of epidemiologic evidence that the use of unopposed estrogens in menopause increases the risk of cutaneous melanoma, while the addition of progestins might counteract the detrimental effect.
关于激素替代疗法（menopausal hormone therapy）与皮肤黑色素瘤（cutaneous melanoma）风险之间的关联，目前存在高度争议。我们在一项芬兰全国范围内的 50 岁及以上女性队列研究中对此问题进行了调查。
通过国家医疗报销登记处确定了所有在 1994 年至 2007 年间购买过激素替代疗法的女性，并将其与芬兰癌症登记处相关联。我们计算了标准化发病比（standardized incidence ratios，SIR）来比较激素替代疗法使用者与普通人群中皮肤黑色素瘤的发病率。
在平均 15.6 年的随访期间，在至少使用了 6 个月激素替代疗法的 293570 名女性中，发现了 1695 例皮肤黑色素瘤病例。使用单纯雌激素治疗（unopposed estrogen therapy）和联合雌激素-孕激素治疗（combined estrogen-progestin therapy，EPT）6 至 59 个月的女性的 SIR 分别为 1.20（95%置信区间[CI]，1.06-1.35）和 1.00（95% CI，0.87-1.14； = 0.04）。使用雌激素治疗和 EPT 至少 60 个月的女性的 SIR 分别为 1.37（95% CI，1.22-1.52）和 1.23（95% CI，1.13-1.34； = 0.15）。我们没有发现口服和经皮给药之间以及雌激素剂量之间存在显著差异。
激素替代疗法的使用，特别是雌激素治疗，与皮肤黑色素瘤的风险增加有关。EPT 使用时间不足 5 年与皮肤黑色素瘤风险增加无关。
我们的研究结果增加了越来越多的流行病学证据，即绝经后使用单纯雌激素会增加皮肤黑色素瘤的风险，而添加孕激素可能会抵消其有害影响。
