Department of Oncology, Odense University Hospital, Odense, Denmark.
Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
J Natl Cancer Inst. 2022 Oct 6;114(10):1347-1354. doi: 10.1093/jnci/djac112.
Women treated for breast cancer (BC) often suffer genitourinary syndrome of menopause. These symptoms may be alleviated by vaginal estrogen therapy (VET) or menopausal hormone therapy (MHT). However, there are concerns of risks of recurrence of BC and death following treatment.
Our study included longitudinal data from a national cohort of postmenopausal women, diagnosed 1997-2004 with early-stage invasive estrogen receptor-positive nonmetastatic BC, who received no treatment or 5 years of adjuvant endocrine therapy. We ascertained prescription data on hormone therapy, VET or MHT, from a national prescription registry. We evaluated mortality and risk of recurrence associated with use of VET and MHT vs non-use using multivariable models adjusted for potential confounders.
Among 8461 women who had not received VET or MHT before BC diagnosis, 1957 and 133 used VET and MHT, respectively, after diagnosis. Median follow-up was 9.8 years for recurrence and 15.2 years for mortality. The adjusted relative risk of recurrence was 1.08 (95% confidence interval [CI] = 0.89 to 1.32) for VET (1.39 [95% CI = 1.04 to 1.85 in the subgroup receiving adjuvant aromatase inhibitors]) and 1.05 (95% CI = 0.62 to 1.78) for MHT. The adjusted hazard ratios for overall mortality were 0.78 (95% CI = 0.71 to 0.87) and 0.94 (95% CI = 0.70 to 1.26) for VET and MHT, respectively.
In postmenopausal women treated for early-stage estrogen receptor-positive BC, neither VET nor MHT was associated with increased risk of recurrence or mortality. A subgroup analysis revealed an increased risk of recurrence, but not mortality, in patients receiving VET with adjuvant aromatase inhibitors.
接受乳腺癌（BC）治疗的女性经常患有绝经后生殖泌尿系统综合征。这些症状可以通过阴道雌激素治疗（VET）或绝经激素治疗（MHT）来缓解。然而，人们担心治疗后 BC 复发和死亡的风险。
我们的研究包括来自一个全国绝经后女性队列的纵向数据，这些女性在 1997 年至 2004 年间被诊断为早期浸润性雌激素受体阳性非转移性 BC，未接受治疗或接受 5 年辅助内分泌治疗。我们从国家处方登记处获得了关于激素治疗、VET 或 MHT 的处方数据。我们使用多变量模型评估了与 VET 和 MHT 使用与不使用相关的死亡率和复发风险，该模型调整了潜在混杂因素。
在 8461 名未在 BC 诊断前接受 VET 或 MHT 的女性中，分别有 1957 名和 133 名在诊断后使用了 VET 和 MHT。复发的中位随访时间为 9.8 年，死亡的中位随访时间为 15.2 年。VET 的复发相对风险为 1.08（95%置信区间[CI] = 0.89 至 1.32）（接受辅助芳香化酶抑制剂治疗的亚组为 1.39 [95%CI = 1.04 至 1.85]），MHT 的复发相对风险为 1.05（95%CI = 0.62 至 1.78）。VET 和 MHT 的总死亡率的调整危险比分别为 0.78（95%CI = 0.71 至 0.87）和 0.94（95%CI = 0.70 至 1.26）。
在接受早期雌激素受体阳性 BC 治疗的绝经后女性中，VET 或 MHT 均与复发或死亡率增加无关。亚组分析显示，接受辅助芳香化酶抑制剂治疗的患者 VET 治疗后复发风险增加，但死亡率未增加。
