Persson I, Yuen J, Bergkvist L, Schairer C
Department of Cancer Epidemiology, University Hospital, Uppsala, Sweden.
Int J Cancer. 1996 Jul 29;67(3):327-32. doi: 10.1002/(SICI)1097-0215(19960729)67:3<327::AID-IJC4>3.0.CO;2-T.
We analyzed cancer incidence and mortality in a cohort of 22,597 Swedish women who were prescribed replacement hormones. After 13 years of follow-up in national registries, 2,330 incident cancer cases and 848 cancer deaths were observed. Overall, our results were reassuring since incidence rate ratios (SIRs) for 16 cancer sites and mortality ratios (SMRs) for all 10 examined sites were at, or lower than, unity. However, we found that exposure to an estrogen-progestin combined brand was associated with an increasing relative risk of breast cancer with follow-up time, the SIR reaching 1.4 (95% CI 1.1-1.8) after 10 years of follow-up. The relative risk of endometrial cancer was substantially increased, with the highest SIR of 5.0 (95% CI 1.6-5.9) in women prescribed estrogens alone, whereas those given an estrogen-progestin combination showed no elevation in risk. The risk estimates for liver and biliary tract cancers and for colon cancer were reduced by about 40%, notably in women prescribed the estradiol-progestin compound. Further detailed analyses revealed no evidence of adverse or protective effects on the risk of ovarian, uterine cervical, vulvar/vaginal, rectal, pancreatic, renal, lung, thyroid and other endocrine cancers, brain tumors, malignant melanoma or other skin cancers. Hormone replacement therapy was not associated with an increase in mortality for any cancer site, at this time of follow-up. For breast and endometrial cancers, SMRs were below baseline but tended to increase with follow-up time. We conclude that hormone replacement increases the endometrial-cancer risk after unopposed estrogens and the breast-cancer risk-notably after estrogen-progestin combined therapy-and tentatively suggest that it exerts a protective effect against colon and liver cancer risks.
我们分析了22597名接受替代激素治疗的瑞典女性队列中的癌症发病率和死亡率。在国家登记处进行了13年的随访后，观察到2330例新发癌症病例和848例癌症死亡。总体而言，我们的结果令人安心，因为16个癌症部位的发病率比值比（SIRs）以及所有10个检查部位的死亡率比值比（SMRs）均等于或低于1。然而，我们发现，使用雌激素 - 孕激素联合制剂与随访时间延长导致的乳腺癌相对风险增加有关，随访10年后SIR达到1.4（95%可信区间1.1 - 1.8）。子宫内膜癌的相对风险大幅增加，单独使用雌激素的女性中最高SIR为5.0（95%可信区间1.6 - 5.9），而使用雌激素 - 孕激素联合制剂的女性风险未升高。肝脏和胆道癌以及结肠癌的风险估计降低了约40%，尤其是在使用雌二醇 - 孕激素复合制剂的女性中。进一步的详细分析显示，没有证据表明对卵巢癌、子宫颈癌、外阴/阴道癌、直肠癌、胰腺癌、肾癌、肺癌、甲状腺癌和其他内分泌癌、脑肿瘤、恶性黑色素瘤或其他皮肤癌的风险有不良或保护作用。在本次随访时，激素替代疗法与任何癌症部位的死亡率增加均无关。对于乳腺癌和子宫内膜癌，SMRs低于基线，但随随访时间有升高趋势。我们得出结论，激素替代在使用无对抗雌激素后会增加子宫内膜癌风险，在雌激素 - 孕激素联合治疗后会显著增加乳腺癌风险，并初步表明它对结肠癌和肝癌风险具有保护作用。
