Department of Research, Cancer Registry of Norway, Norwegian Institute of Public Health, Oslo, Norway.
Norwegian Research Centre for Women's Health, Division of Obstetrics and Gynecology, Oslo University Hospital, Oslo, Norway.
Br J Cancer. 2024 Jul;131(1):126-137. doi: 10.1038/s41416-024-02590-1. Epub 2024 May 13.
It is important to monitor the association between menopausal hormone therapy (HT) use and breast cancer (BC) risk with contemporary estimates, and specifically focus on HT types and new drugs.
We estimated hazard ratios (HR) of BC risk according to HT type, administration route and individual drugs, overall and stratified by body mass index (BMI), molecular subtype and detection mode, with non-HT use as reference.
We included 1,275,783 women, 45+ years, followed from 2004, for a median of 12.7 years. Oral oestrogen combined with daily progestin was associated with the highest risk of BC (HR 2.42, 95% confidence interval (CI) 2.31-2.54), with drug-specific HRs ranging from Cliovelle®: 1.63 (95% CI 1.35-1.96) to Kliogest®: 2.67 (2.37-3.00). Vaginal oestradiol was not associated with BC risk. HT use was more strongly associated with luminal A cancer (HR 1.97, 95% CI 1.86-2.09) than other molecular subtypes, and more strongly with interval (HR 2.00, 95% CI: 1.83-2.30) than screen-detected (HR 1.33, 95% CI 1.26-1.41) BC in women 50-71 years. HRs for HT use decreased with increasing BMI.
The use of oral and transdermal HT was associated with an increased risk of BC. The associations varied according to HT type, individual drugs, molecular subtype, detection mode and BMI.
监测绝经激素治疗（HT）使用与乳腺癌（BC）风险之间的关联非常重要，尤其是需要关注 HT 类型和新药。
我们根据 HT 类型、给药途径和个别药物，总体以及按体重指数（BMI）、分子亚型和检测模式分层，来估计 BC 风险的危险比（HR），以非 HT 使用者为参照。
我们纳入了 1275783 名 45 岁以上的女性，从 2004 年开始随访，中位随访时间为 12.7 年。口服雌激素联合每日孕激素联合使用与 BC 风险最高相关（HR 2.42，95%置信区间（CI）2.31-2.54），特定药物的 HR 范围从 Cliovelle®：1.63（95% CI 1.35-1.96）到 Kliogest®：2.67（2.37-3.00）。阴道用雌二醇与 BC 风险无关。HT 使用与管腔 A 型癌症的相关性更强（HR 1.97，95% CI 1.86-2.09），而与其他分子亚型的相关性较弱，与间隔期（HR 2.00，95% CI：1.83-2.30）相比，与筛查检测（HR 1.33，95% CI 1.26-1.41）相比相关性更强，50-71 岁女性中。随着 BMI 的增加，HT 使用的 HR 降低。
口服和透皮 HT 的使用与 BC 风险增加相关。关联因 HT 类型、个别药物、分子亚型、检测模式和 BMI 而异。
