Persson I, Thurfjell E, Holmberg L
Department of Cancer Epidemiology, University Hospital, Uppsala, Sweden.
J Clin Oncol. 1997 Oct;15(10):3201-7. doi: 10.1200/JCO.1997.15.10.3201.
Hormone replacement therapy (HRT) may increase the mammographic density with a possible reduction in the sensitivity or specificity. If so, the benefit of mammographic screening in women using HRT could be compromised. We evaluated the hypothesis that HRT regimens have differential effects on the mammographic density depending on treatment regimens or on age.
Among 31,498 Swedish women who received mammographic screening, we selected 554 women who started HRT after the first examination and who were current users at the second, and 554 age-matched women who had never received HRT. Mammograms were examined in a blinded review. The changes in density between the two examinations, graded as moderate or weak reduction, no change, or weak, moderate, or substantial increase, were assessed. We studied four HRT regimens-estradiol compounds only, estradiol compounds cyclically or continuously combined with progestins, and weak estrogens-and used descriptive statistics and logistic regression to analyze the association between HRT and density change.
Density increased in 10% and 28% of women who received estradiol compounds with cyclically or continuously combined progestins, respectively, but in only 3% of unexposed women. Logistic regression analyses showed an elevated risk of a density increase (relative risk [RR] = 3.6; 95% confidence interval [CI], 1.6 to 7.7) in women who received cyclically combined regimens or continuously combined regimens (RR = 12.4; 95% CI, 6.3 to 24.4) compared with unexposed women. Women > or = 50 years of age had even stronger associations; RRs in women on estradiol only, the cyclically combined and the continuously combined regimens were 32.2 (95% CI, 3.9 to 267.5), 21.9 (95% CI, 1.9 to 251.5), and 176.9 (95% CI, 22.8 to 1,372.7), respectively.
HRT with estradiol-progestin regimens, especially continuously combined, may increase the mammographic density in a substantial proportion of women.
激素替代疗法（HRT）可能会增加乳房X线摄影密度，这可能会降低其敏感性或特异性。如果是这样，那么HRT使用者进行乳房X线筛查的益处可能会受到影响。我们评估了这样一个假设，即HRT方案对乳房X线摄影密度的影响因治疗方案或年龄而异。
在31498名接受乳房X线筛查的瑞典女性中，我们选择了554名在首次检查后开始使用HRT且在第二次检查时仍在使用的女性，以及554名年龄匹配但从未接受过HRT的女性。乳房X线照片由专人进行盲法评估。评估两次检查之间密度的变化，分为密度中度或轻度降低、无变化、或密度轻度、中度或显著增加。我们研究了四种HRT方案——仅使用雌二醇化合物、雌二醇化合物与孕激素周期性或连续性联合使用、以及弱雌激素——并使用描述性统计和逻辑回归分析HRT与密度变化之间的关联。
分别有10%和28%接受雌二醇化合物与孕激素周期性或连续性联合使用的女性密度增加，但未接受HRT的女性中只有3%密度增加。逻辑回归分析显示，与未接受HRT的女性相比，接受周期性联合方案或连续性联合方案的女性密度增加的风险升高（相对风险[RR]=3.6；95%置信区间[CI]，1.6至7.7），接受连续性联合方案的女性风险更高（RR=12.4；95%CI，6.3至24.4）。年龄≥50岁的女性关联更强；仅使用雌二醇、周期性联合和连续性联合方案的女性RR分别为32.2（95%CI，3.9至267.5）、21.9（95%CI，1.9至251.5）和176.9（95%CI，22.8至1372.7）。
使用雌二醇-孕激素方案的HRT，尤其是连续性联合方案，可能会使相当一部分女性的乳房X线摄影密度增加。
