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[更年期激素治疗与乳腺癌。]

[Menopausal hormonal therapy and breast cancer.].

作者信息

Bakhidze E V, Belyaeva A V, Berlev I V, Anisimov V N, Belyaev A M

机构信息

N.N.Petrov National Medical Research Center of Oncology, 68 Leningradskaya str., Pesochny, St. Petersburg 197758, Russian Federation, e-mail:

I.I.Mechnikov North-Western State Medical University, 41 Kirochnaya str., St. Petersburg 191015, Russian Federation.

出版信息

Adv Gerontol. 2021;34(2):277-286.

Abstract

The most common treatment for menopausal syndrome is menopausal hormone therapy (MHT), however, the safety of MHT, due to the risk of developing and recurrent breast cancer (BC), is still a matter of debate. The review presents the results of randomized cohort studies of this issue. It has been shown that MHT increases the risk of developing of breast cancer and disease recurrence after treatment. Risk of breast cancer developing in women getting MHT, depends on body mass index (BMI), duration of hormone use and dose of drugs, and is greater in thin women comparing with women with increased BMI, and also greater in estrogen-progestin combined MHT users comparing with estrogen-only users. It was found that in women using MHT hormone-dependent forms of cancer developed more often, but by the time of diagnosis, disease was found in more advanced stage and metastases in lymph nodes were found more often comparing with patients who did not use MHT. Risk of breast cancer recurrence is less with the use of low doses of vaginal estrogen. An alternative option for the relief of menopausal disorders in breast cancer patients during and after treatment is using of pineal gland hormone melatonin, since, along with its anti-aging properties, it is able to suppress cancer at the stages of initiation, progression and metastasis and has the ability to reduce the toxic effects of anticancer drugs while increasing their effectiveness.

摘要

更年期综合征最常见的治疗方法是更年期激素疗法(MHT),然而,由于存在患乳腺癌(BC)及复发的风险,MHT的安全性仍存在争议。这篇综述展示了关于此问题的随机队列研究结果。研究表明,MHT会增加患乳腺癌的风险以及治疗后疾病复发的风险。接受MHT治疗的女性患乳腺癌的风险,取决于体重指数(BMI)、激素使用时长和药物剂量,与BMI较高的女性相比,瘦女性的风险更高,与仅使用雌激素的女性相比,使用雌激素 - 孕激素联合MHT的女性风险也更高。研究发现,使用MHT的女性更常发生激素依赖性癌症,但与未使用MHT的患者相比,在诊断时,疾病处于更晚期且更常发现淋巴结转移。使用低剂量阴道雌激素时,乳腺癌复发风险较低。对于乳腺癌患者在治疗期间及治疗后的更年期症状缓解,另一种选择是使用松果体激素褪黑素,因为它除了具有抗衰老特性外,还能够在癌症的起始、进展和转移阶段抑制癌症,并且有能力降低抗癌药物的毒性作用,同时提高其疗效。

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