Gambrell R D
Department of Physiology and Endocrinology, Medical College of Georgia, Augusta, USA.
Arch Fam Med. 1996 Jun;5(6):341-8.
The role of estrogen therapy in the risk of breast cancer has been a concern for both physicians and patients. There is some evidence that women taking estrogen who develop breast cancer have a better prognosis. During 8 to 18 years of follow-up of 256 postmenopausal women with breast cancer from our hospital, median survival time was 84 months for those who never used estrogen, 80 months for past users, and 143 months for current users. More than 50 studies have shown that there is no increased risk of breast cancer even with long-term estrogen use, while some studies suggest an increased risk. Several studies indicate that when progestogens are added to estrogen therapy, there is a significant reduction in the risk of breast carcinoma. Indirect evidence is accumulating to show why added progestogen should decrease the risk of breast cancer. Preliminary studies further indicate that estrogen therapy, which has been contraindicated in breast cancer survivors in the past, may be safe, and added progestogens may decrease recurrences and deaths. Some medical oncologists and surgeons now advocate estrogen use in women with previous carcinoma of the breast.
雌激素疗法在乳腺癌风险中所起的作用一直是医生和患者关注的问题。有证据表明，患乳腺癌的女性在服用雌激素后预后较好。在对我院256名绝经后乳腺癌女性进行的8至18年随访中，从未使用过雌激素的患者中位生存时间为84个月，既往使用者为80个月，目前使用者为143个月。50多项研究表明，即使长期使用雌激素，患乳腺癌的风险也不会增加，而一些研究则表明风险会增加。几项研究表明，在雌激素疗法中添加孕激素后，乳腺癌风险会显著降低。越来越多的间接证据表明添加孕激素可降低乳腺癌风险的原因。初步研究进一步表明，过去在乳腺癌幸存者中被视为禁忌的雌激素疗法可能是安全的，添加孕激素可能会减少复发和死亡。现在一些肿瘤内科医生和外科医生主张对既往有乳腺癌的女性使用雌激素。
