Siitonen Heli, Joensuu Johanna, Savolainen-Peltonen Hanna, Gissler Mika, Ylikorkala Olavi, Mikkola Tomi S
University of Helsinki and Helsinki University Hospital, Department of Obstetrics and Gynecology, Helsinki FI-00290, Finland.
Karolinska Institutet, Department of Molecular Medicine and Surgery, Stockholm SE-171 76, Sweden; Region Stockholm, Academic Primary Health Care Centre, Stockholm SE-104 31, Sweden; Finnish Institute for Health and Welfare, Department of Data and Analysis, Helsinki FI-00300, Finland.
Eur J Cancer. 2025 May 2;220:115340. doi: 10.1016/j.ejca.2025.115340. Epub 2025 Mar 11.
We assessed menopausal hormone therapy (MHT) -related invasive breast cancer (BC) risks among more recent MHT users to compare this data with older national and international data.
We identified in this nationwide cohort study MHT users (n = 357 928) in 1994-2019 from the medical reimbursement register and age-matched non-users (n = 351 735) from the national population register and followed them for the occurrence of invasive BC with the aid of the Finnish Cancer Registry. The unadjusted BC risks were calculated as odds ratios (ORs) and 95 % confidence intervals (CIs).
During a median of 18 years and 13 million person-years, 23 571 MHT users (6.6 %) and 17 192 non-users (4.9 %) were diagnosed with invasive BC (p < 0.001), and the median detection year was 2011. Ever use of estrogen-only therapy for 5-9 years (OR 1.61; 95 % CI 1.51-1.71) or tibolone for ≤ 10 years (1.30; 1.02-1.67) was accompanied by smaller risk elevations than use of estrogen-progestogen therapy (EPT) for the same duration (1.82; 1.76-1.88 and 1.98; 1.91-2.06). Dydrogesterone-EPT for 5-9 years was associated with a smaller risk increase (1.32; 1.12-1.55) than other EPT regimens (1.76-2.16; 1.62-2.30). The BC risks remained elevated 5-10 years after cessation of MHT with most of the regimens.
Despite possible changes towards safer MHT prescribing, our data collected largely in early millennium show at least as large BC risk elevations in MHT users as seen in older studies.
我们评估了近期使用更年期激素疗法（MHT）的人群中与MHT相关的浸润性乳腺癌（BC）风险，以便将该数据与较早的国内和国际数据进行比较。
在这项全国性队列研究中，我们从医疗报销登记册中识别出1994 - 2019年期间的MHT使用者（n = 357928），并从国家人口登记册中选取年龄匹配的非使用者（n = 351735），借助芬兰癌症登记处追踪他们浸润性BC的发生情况。未调整的BC风险以比值比（OR）和95%置信区间（CI）计算。
在中位18年和1300万人年的随访期间，23571名MHT使用者（6.6%）和17192名非使用者（4.9%）被诊断为浸润性BC（p < 0.001），中位诊断年份为2011年。与相同疗程使用雌激素 - 孕激素疗法（EPT）相比，仅使用雌激素疗法5 - 9年（OR 1.61；95% CI 1.51 - 1.71）或替勃龙使用≤10年（1.30；1.02 - 1.67）时风险升高幅度较小（EPT相同疗程时为1.82；1.76 - 1.88和1.98；1.91 - 2.06）。与其他EPT方案（1.76 - 2.16；1.62 - 2.30）相比，使用地屈孕酮 - EPT 5 - 9年时风险增加幅度较小（1.32；1.12 - 1.55）。在大多数方案中，MHT停止后5 - 10年BC风险仍保持升高。
尽管MHT处方可能已朝着更安全的方向转变，但我们在新千年初期收集的数据显示，MHT使用者中BC风险升高幅度至少与早期研究中所见一样大。
