Leventea Eleni, Harkness Elaine F, Brentnall Adam R, Howell Anthony, Evans D Gareth, Harvie Michelle
Department of Nutrition and Dietetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK.
Nightingale Breast Screening Centre & Prevent Breast Cancer Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK.
Cancers (Basel). 2021 May 31;13(11):2710. doi: 10.3390/cancers13112710.
Menopausal hormone therapy (MHT) has an attenuated effect on breast cancer (BC) risk amongst heavier women, but there are few data on a potential interaction with early adulthood body mass index (at age 20 years) and age of first pregnancy. We studied 56,489 women recruited to the PROCAS (Predicting Risk of Cancer at Screening) study in Manchester UK, 2009-15. Cox regression models estimated the effect of reported MHT use at entry on breast cancer (BC) risk, and potential interactions with a. self-reported current body mass index (BMI), b. BMI aged 20 and c. First pregnancy >30 years or nulliparity compared with first pregnancy <30 years. Analysis was adjusted for age, height, family history, age of menarche and menopause, menopausal status, oophorectomy, ethnicity, self-reported exercise and alcohol. With median follow up of 8 years, 1663 breast cancers occurred. BC risk was elevated amongst current users of combined MHT compared to never users (Hazard ratioHR 1.64, 95% CI 1.32-2.03), risk was higher than for oestrogen only users (HR 1.03, 95% CI 0.79-1.34). Risk of current MHT was attenuated by current BMI (interaction HR 0.80, 95% CI 0.65-0.99) per 5 unit increase in BMI. There was little evidence of an interaction between MHT use, breast cancer risk and early and current BMI or with age of first pregnancy.
在体重较大的女性中，绝经激素治疗（MHT）对乳腺癌（BC）风险的影响减弱，但关于其与成年早期体重指数（20岁时）和首次怀孕年龄之间潜在相互作用的数据很少。我们研究了2009年至2015年在英国曼彻斯特招募到PROCAS（筛查时预测癌症风险）研究中的56489名女性。Cox回归模型估计了入组时报告的MHT使用情况对乳腺癌（BC）风险的影响，以及与以下因素的潜在相互作用：a. 自我报告的当前体重指数（BMI）；b. 20岁时的BMI；c. 与首次怀孕年龄小于30岁相比，首次怀孕年龄大于30岁或未生育。分析对年龄、身高、家族病史、初潮和绝经年龄、绝经状态、卵巢切除术、种族、自我报告的运动和饮酒情况进行了调整。中位随访8年，共发生1663例乳腺癌。与从未使用过MHT的女性相比，联合使用MHT的女性患BC的风险升高（风险比HR 1.64，95%可信区间1.32 - 2.03），风险高于仅使用雌激素的女性（HR 1.03，95%可信区间0.79 - 1.34）。每增加5个单位的BMI，当前MHT的风险因当前BMI而减弱（相互作用HR 0.80，95%可信区间0.65 - 0.99）。几乎没有证据表明MHT使用、乳腺癌风险与早期和当前BMI或首次怀孕年龄之间存在相互作用。
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