Greenblatt R B, Stoddard L D
J Am Geriatr Soc. 1978 Jan;26(1):1-8. doi: 10.1111/j.1532-5415.1978.tb01947.x.
Postmenopausal women should not be denied estrogen therapy because of the controversy about the alleged causal relationship of estrogens to endometrial cancer. A prestigious team of biostatisticians reviewed three publications that claimed this relationship and concluded that no such association could be confirmed. Although the incidence of endometrial cancer has doubled in the past 25 years, there is no valid basis for the assumption that the widespread use of estrogens is the cause. The incidence also has increased in Norway and Czechoslovakia where estrogens are rarely used. Moreover, the histologic pattern of endometrial dysplasias is such that many pathologists will make a diagnosis of endometrial cancer as a safeguard for the patient. Thus the statistics for the incidence of endometrial cancer may be inflated. As a test, the administration of 200 mg of an oral progestogen over 5-10 days will convert a histologic pattern of pseudomalignancy, but not of adenocarcinoma, into one of secretory endometrium. Unopposed endogenous or exogenous estrogens may induce hyperplasia, atypical adenomatous hyperplasia or adenocarcinoma in women who are genetically predisposed. To minimize such a possibility, it is advisable to give a 5-7 day course of an oral progestogen so that the endometrium will be shed as monthly intevals. The benefits of hormone replacement therapy for the postmenopausal woman far outweigh the putative risk of endometrial cancer.
绝经后女性不应因雌激素与子宫内膜癌之间所谓因果关系的争议而被拒绝接受雌激素治疗。一个颇具声望的生物统计学家团队审查了三篇声称存在这种关系的出版物，并得出结论，无法证实这种关联。尽管在过去25年中子宫内膜癌的发病率翻了一番，但认为雌激素的广泛使用是病因这一假设并无有效依据。在挪威和捷克斯洛伐克，雌激素很少使用，但子宫内膜癌的发病率也有所上升。此外，子宫内膜发育异常的组织学模式使得许多病理学家会将其诊断为子宫内膜癌，以保障患者安全。因此，子宫内膜癌发病率的统计数据可能被夸大了。作为一项测试，在5至10天内给予200毫克口服孕激素，会将假恶性而非腺癌的组织学模式转变为分泌期子宫内膜模式。未对抗的内源性或外源性雌激素可能会在具有遗传易感性的女性中诱发增生、非典型腺瘤样增生或腺癌。为尽量减少这种可能性，建议给予5至7天疗程的口服孕激素，以便子宫内膜能按月间隔脱落。激素替代疗法对绝经后女性的益处远远超过假定的子宫内膜癌风险。
