de Waard F, de Ridder C M, Baanders-van Halewyn E A, Slotboom B J
Department of Epidemiology, University of Utrecht, The Netherlands.
Eur J Cancer Prev. 1996 Apr;5(2):99-104. doi: 10.1097/00008469-199604000-00003.
In a cohort of 25,000 women aged 40-65 years at intake in a periodic screening programme for breast cancer the occurrence of endometrial cancer was studied during a follow-up period of up to 18 years. The authors examined whether they could confirm the existence of a number of relationships between this cancer and some reproductive and anthropometric factors which had been found in several case-control studies and in a few cohort studies. A comparison was made between 147 cases of endometrial cancer occurring during the period of follow-up and a random sample of 900 women taken from the cohort (334 being premenopausal and 566 postmenopausal on the day of intake). An inverse relationship between number of children and endometrial cancer risk was found in the older group; the excess risk among nulliparous women was stronger in married than in single women. Late age at menopause (after age 52) was associated with increased risk. Use of oestrogenic drugs on day of intake for alleviating perimenopausal complaints (reported in 8% of women) increased risk, especially in the younger group. Body weight was positively associated with risk (with an odds ratio of 4 in those over 80 kg) among postmenopausal women. Because there appeared to be a moderately strong risk associated with tall height, especially among postmenopausal women, Quetelet's index performed less well than body weight itself. Nevertheless, subscapular and triceps skinfold thicknesses confirmed an effect of fatness on risk. These results are discussed with reference to other epidemiological studies, in particular two cohort studies from Norway. The effect of height, convincingly shown by Tretli and Magnus in 1990, is explained in a way which does not assume causal mechanisms operating at a young age: absolute fat mass rather than relative weight is regarded as the main determinant of risk in postmenopausal women.
在一项针对25000名年龄在40至65岁的女性的乳腺癌定期筛查项目中，研究了她们在长达18年的随访期内子宫内膜癌的发病情况。作者检验了能否证实这种癌症与一些生殖和人体测量因素之间存在若干关联，这些关联在一些病例对照研究和少数队列研究中已被发现。对随访期间发生的147例子宫内膜癌病例与从该队列中随机抽取的900名女性进行了比较（入组当天334名处于绝经前，566名处于绝经后）。在年龄较大的组中发现子女数量与子宫内膜癌风险呈负相关；未生育女性的额外风险在已婚女性中比单身女性更强。绝经年龄较晚（52岁以后）与风险增加有关。入组当天使用雌激素药物缓解围绝经期症状（8%的女性报告有此情况）会增加风险，尤其是在较年轻的组中。绝经后女性的体重与风险呈正相关（体重超过80公斤者的优势比为4）。由于身高似乎与风险有中度较强的关联，尤其是在绝经后女性中，奎特利指数的表现不如体重本身。然而，肩胛下和肱三头肌皮褶厚度证实了肥胖对风险的影响。参照其他流行病学研究，特别是挪威的两项队列研究对这些结果进行了讨论。1990年特雷利和马格努斯令人信服地表明的身高影响，以一种不假定年轻时存在因果机制的方式进行了解释：绝经后女性风险的主要决定因素被认为是绝对脂肪量而非相对体重。
