Helzlsouer K J, Couzi R
Department of Epidemiology, Johns Hopkins University, Baltimore, MD 21205, USA.
Cancer. 1995 Nov 15;76(10 Suppl):2059-63. doi: 10.1002/1097-0142(19951115)76:10+<2059::aid-cncr2820761325>3.0.co;2-1.
The exact nature of the association between hormones and the development of breast cancer remains uncertain. Studies of endogenous hormone levels and breast cancer suggest a possible role of estrogens and androgens in the cause of breast cancer. Numerous studies have been conducted to assess the risk of breast cancer among women exposed to exogenous hormones. Several studies of women who have used oral contraceptives have shown a twofold increase in risk for the onset of breast cancer at an early age associated with 10 years of oral contraceptive use. One of the largest studies, the Cancer and Steroid Hormone Study, found no association between breast cancer and oral contraceptive use for women up to the age of 54. A meta-analysis combining the results of 31 published studies of the association between hormone replacement therapy and breast cancer revealed no increased risk of breast cancer associated with ever-use (risk ratio [RR], 1.02; 95% confidence interval [CI], 0.93-1.12). Use of oral contraceptives for more than 10 years was associated with a small increased risk (RR, 1.23; 95% CI, 1.08-1.40), but few studies have examined very long term use. A recent study of pregnancy and breast cancer outcome found no adverse influence of pregnancy shortly before or after diagnosis of breast cancer on prognosis. The results of a wide range of studies should be considered when weighing the benefits and risks of hormone use among women at increased risk of breast cancer or with a history of breast cancer.
激素与乳腺癌发展之间关联的确切性质仍不确定。对内源性激素水平与乳腺癌的研究表明，雌激素和雄激素在乳腺癌病因中可能发挥作用。已经开展了大量研究来评估接触外源性激素的女性患乳腺癌的风险。几项针对使用口服避孕药女性的研究显示，使用10年口服避孕药与早年患乳腺癌风险增加两倍有关。规模最大的研究之一，即癌症与类固醇激素研究，发现54岁及以下女性患乳腺癌与使用口服避孕药之间没有关联。一项对31项已发表的激素替代疗法与乳腺癌关联研究结果进行综合分析的meta分析显示，既往使用激素替代疗法与患乳腺癌风险增加无关（风险比[RR]为1.02；95%置信区间[CI]为0.93 - 1.12）。使用口服避孕药超过10年与患癌风险小幅增加有关（RR为1.23；95% CI为1.08 - 1.40），但很少有研究考察极长期使用情况。最近一项关于妊娠与乳腺癌结局的研究发现，在乳腺癌诊断前后不久怀孕对预后没有不良影响。在权衡乳腺癌风险增加或有乳腺癌病史的女性使用激素的利弊时，应考虑广泛研究的结果。
