Hunter D J, Hankinson S E, Laden F, Colditz G A, Manson J E, Willett W C, Speizer F E, Wolff M S
Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA 02115, USA.
N Engl J Med. 1997 Oct 30;337(18):1253-8. doi: 10.1056/NEJM199710303371801.
Exposure to "environmental estrogens" such as organochlorines in pesticides and industrial chemicals has been proposed as a cause of increasing rates of breast cancer. Several studies have reported higher blood levels of 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (DDE) and polychlorinated biphenyls (PCBs) in patients with breast cancer than in controls.
We measured plasma levels of DDE and PCBs prospectively among 240 women who gave a blood sample in 1989 or 1990 and who were subsequently given a diagnosis of breast cancer before June 1, 1992. We compared these levels with those measured in matched control women in whom breast cancer did not develop. Data on DDE were available for 236 pairs, and data on PCBs were available for 230 pairs.
The median level of DDE was lower among case patients than among controls (4.71 vs. 5.35 parts per billion, P=0.14), as was the median level of PCBs (4.49 vs. 4.68 parts per billion, P=0.72). The multivariate relative risk of breast cancer for women in the highest quintile of exposure as compared with women in the lowest quintile was 0.72 for DDE (95 percent confidence interval, 0.37 to 1.40) and 0.66 for PCBs (95 percent confidence interval, 0.32 to 1.37). Exposure to high levels of both DDE and PCBs was associated with a nonsignificantly lower risk of breast cancer (relative risk for women in the highest quintiles of both DDE and PCBs as compared with women in the lowest, 0.43; 95 percent confidence interval, 0.13 to 1.44).
Our data do not support the hypothesis that exposure to DDT and PCBs increases the risk of breast cancer.
接触农药和工业化学品中的有机氯等“环境雌激素”被认为是乳腺癌发病率上升的一个原因。几项研究报告称，乳腺癌患者血液中的1,1-二氯-2,2-双（对氯苯基）乙烯（DDE）和多氯联苯（PCBs）水平高于对照组。
我们前瞻性地测量了1989年或1990年提供血样且随后在1992年6月1日前被诊断为乳腺癌的240名女性的血浆DDE和PCBs水平。我们将这些水平与未患乳腺癌的匹配对照女性的测量水平进行了比较。有236对数据可用于DDE，230对数据可用于PCBs。
病例患者中DDE的中位数水平低于对照组（4.71 vs. 5.35十亿分之一，P = 0.14），PCBs的中位数水平也是如此（4.49 vs. 4.68十亿分之一，P = 0.72）。与暴露于最低五分位数的女性相比，暴露于最高五分位数的女性患乳腺癌的多变量相对风险，DDE为0.72（95%置信区间，0.37至1.40），PCBs为0.66（95%置信区间，0.32至1.37）。同时暴露于高水平的DDE和PCBs与患乳腺癌风险略低相关（与最低五分位数的女性相比，DDE和PCBs最高五分位数的女性相对风险为0.43；95%置信区间，0.13至1.44）。
我们的数据不支持接触滴滴涕和多氯联苯会增加患乳腺癌风险这一假设。
