Adami H O, Bergkvist L, Krusemo U, Persson I
J Natl Cancer Inst. 1984 Nov;73(5):1049-55.
A cohort comprising 11,452 women and based on virtually all cases of first incidence of breast cancer in Sweden in 1964-67 was followed for 13-16 completed years--corresponding to 94,078 person-years of observation--for the occurrence of subsequent primary tumors other than in the breast. A slight excess in the total number of second malignant diseases (695 observed vs. 633.7 expected; relative risk (RR) = 1.10) was possibly partly due to a higher autopsy rate with more frequent detection of preclinical cancers in the cohort than in the background population. A significant risk increase was confirmed for endometrial cancer after the age of 70 years (RR = 2.4; 95% confidence limits = 1.6-3.5) but not for ovarian cancer (RR = 1.2) or tumors of the large bowel (RR = 1.2), rectum (RR = 1.1), or any other site. It was concluded that: 1) so many subgroups were analyzed in this study that the significant association with endometrial cancer might be due to the play of chance alone and, therefore, needs further confirmation, 2) there is no common genetically linked susceptibility to primary cancer of the breast and that of other sites, 3) the hypothesis that cancers of the breast and large bowel share major etiologic factors was not supported, and 4) it is unlikely that secondary cancers significantly contribute to the late excess mortality in breast cancer patients.
一个由11452名女性组成的队列，基于1964 - 1967年瑞典几乎所有首次发生乳腺癌的病例，随访了13至16个完整年份——相当于94078人年的观察时间——以观察除乳腺外后续原发性肿瘤的发生情况。第二恶性疾病的总数略有增加（观察到695例，预期633.7例；相对风险（RR）= 1.10），这可能部分归因于该队列的尸检率较高，比背景人群更频繁地检测到临床前癌症。70岁以后子宫内膜癌的风险显著增加得到证实（RR = 2.4；95%置信区间 = 1.6 - 3.5），但卵巢癌（RR = 1.2）、大肠癌（RR = 1.2）、直肠癌（RR = 1.1）或其他任何部位的肿瘤并未出现这种情况。得出的结论是：1）本研究分析的亚组众多，与子宫内膜癌的显著关联可能仅由偶然因素导致，因此需要进一步证实；2）乳腺癌与其他部位的原发性癌症不存在共同的遗传易感性；3）乳腺癌和大肠癌共享主要病因因素的假设未得到支持；4）继发性癌症不太可能对乳腺癌患者的晚期额外死亡率有显著影响。
