Sellers T A, Mink P J, Cerhan J R, Zheng W, Anderson K E, Kushi L H, Folsom A R
Division of Epidemiology, University of Minnesota, Minneapolis 55454, USA.
Ann Intern Med. 1997 Dec 1;127(11):973-80. doi: 10.7326/0003-4819-127-11-199712010-00004.
The risks and benefits of hormone replacement therapy (HRT) are of considerable interest and importance, especially in terms of whether they differ among subsets of women.
To determine whether HRT is associated with increased risks for breast cancer and total mortality in women with a family history of breast cancer.
Prospective cohort study.
Population-based sample of midwestern post-menopausal women enrolled in an observational study of risk factors for cancer.
Random sample of 41,837 female Iowa residents 55 to 69 years of age.
Incidence rates of and relative risks for breast cancer (n = 1085) and total mortality (n = 2035) through 8 years of follow-up were calculated by using data from the State Health Registry of Iowa and the National Death Index.
A family history of breast cancer was reported by 12.2% of the cohort at risk. Among women with a family history of breast cancer, those who currently used HRT and had done so for at least 5 years developed breast cancer at an age-adjusted annual rate of 61 cases per 10,000 person-years (95% CI, 28 to 94 cases); this rate was not statistically significantly higher than the rate in women who had never used HRT (46 cases per 10,000 person-years [CI, 36 to 55 cases]). Among women with a family history, those who used HRT had a significantly lower risk for total mortality than did women who had never used HRT (relative risk, 0.67 [CI, 0.51 to 0.89]), including total cancer-related mortality (relative risk, 0.75 [CI, 0.50 to 1.12]). The age-adjusted annual mortality rate for women using HRT for at least 5 years was 46 deaths per 10,000 person-years (CI, 19 to 74 deaths); this is roughly half the rate seen in women who had never used HRT (80 deaths per 10,000 person-years [CI, 69 to 92 deaths]).
These data suggest that HRT use in women with a family history of breast cancer is not associated with a significantly increased incidence of breast cancer but is associated with a significantly reduced total mortality rate.
激素替代疗法（HRT）的风险与益处备受关注且至关重要，尤其是在不同女性亚组之间是否存在差异方面。
确定HRT是否与有乳腺癌家族史的女性患乳腺癌风险及总死亡率增加相关。
前瞻性队列研究。
基于人群的中西部绝经后女性样本，纳入一项癌症风险因素观察性研究。
41837名年龄在55至69岁的爱荷华州女性居民的随机样本。
通过使用爱荷华州州健康登记处和国家死亡指数的数据，计算随访8年期间乳腺癌（n = 1085）和总死亡率（n = 2035）的发病率和相对风险。
有12.2%的处于风险中的队列报告有乳腺癌家族史。在有乳腺癌家族史的女性中，目前使用HRT且至少使用5年的女性，其年龄调整后的乳腺癌年发病率为每10000人年61例（95%CI，28至94例）；该发病率在统计学上并不显著高于从未使用过HRT的女性（每10000人年46例[CI，36至55例]）。在有家族史的女性中，使用HRT的女性总死亡率显著低于从未使用过HRT的女性（相对风险，0.67[CI，0.51至0.89]），包括与癌症相关的总死亡率（相对风险，0.75[CI，0.50至1.12]）。使用HRT至少5年的女性年龄调整后的年死亡率为每10000人年46例死亡（CI，19至74例死亡）；这大约是从未使用过HRT的女性死亡率（每10000人年80例死亡[CI，69至92例死亡]）的一半。
这些数据表明，有乳腺癌家族史的女性使用HRT与乳腺癌发病率显著增加无关，但与总死亡率显著降低相关。
