绝经后激素使用与结直肠癌和腺瘤的风险

Postmenopausal hormone use and risk for colorectal cancer and adenoma.

作者信息

Grodstein F, Martinez M E, Platz E A, Giovannucci E, Colditz G A, Kautzky M, Fuchs C, Stampfer M J

机构信息

Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

出版信息

Ann Intern Med. 1998 May 1;128(9):705-12. doi: 10.7326/0003-4819-128-9-199805010-00001.

DOI:10.7326/0003-4819-128-9-199805010-00001

PMID:9556463

Abstract

BACKGROUND

Accumulating evidence suggests that postmenopausal hormone use may decrease the risk for colorectal cancer.

OBJECTIVE

To examine the relation of postmenopausal hormone therapy to colorectal adenoma and cancer.

DESIGN

Prospective cohort and nested case-control studies.

SETTING

Nurses' Health Study, a study of registered nurses recruited from 11 U.S. states.

PARTICIPANTS

59 002 postmenopausal participants in the Nurses' Health Study.

MEASUREMENTS

Self-reported data on hormone use and cases of distal colorectal adenoma and colorectal cancer obtained from biennial questionnaires completed from 1980 to 1994. Cases of colorectal adenoma and cancer were confirmed by medical record review.

RESULTS

470 women developed colorectal cancer, and 838 developed distal colorectal adenomas. Current use of postmenopausal hormones was associated with a decreased risk for colorectal cancer (relative risk [RR], 0.65 [95% CI, 0.50 to 0.83]). This association was attenuated in past users (RR, 0.84 [CI, 0.67 to 1.05]) and disappeared 5 years after hormone use was discontinued (RR, 0.92 [CI, 0.70 to 1.21]). Longer duration of current use did not afford greater protection (RR with > or =5 years of use, 0.72 [CI, 0.53 to 0.96]). Even after exclusion of women who reported having screening sigmoidoscopy, the relative risk for colorectal cancer seen with current hormone use was 0.64 (CI, 0.49 to 0.82). This suggests that the apparent protection is unlikely to be due to more intensive screening among hormone users. Current users also had a lower risk for large (> or =1 cm) adenomas than did women who had never used hormones (RR, 0.74 [CI, 0.55 to 0.99]), although no overall material association was seen between colorectal adenoma and current hormone use (RR, 0.91 [CI,0.77 to 1.08]).

CONCLUSIONS

The risk for colorectal cancer was decreased among women currently receiving postmenopausal hormone therapy, but the apparent reduction substantially diminished upon cessation of therapy. Hormone use was inversely associated with large colorectal adenomas but not small ones.

摘要

背景

越来越多的证据表明，绝经后激素使用可能会降低患结直肠癌的风险。

目的

研究绝经后激素治疗与结直肠腺瘤及癌症之间的关系。

设计

前瞻性队列研究和巢式病例对照研究。

地点

护士健康研究，该研究对从美国11个州招募的注册护士进行。

参与者

护士健康研究中的59002名绝经后参与者。

测量方法

通过1980年至1994年每两年填写一次的问卷获得关于激素使用情况以及远端结直肠腺瘤和结直肠癌病例的自我报告数据。结直肠腺瘤和癌症病例通过病历审查得以确认。

结果

470名女性患了结直肠癌，838名患了远端结直肠腺瘤。当前使用绝经后激素与结直肠癌风险降低相关（相对风险[RR]，0.65[95%可信区间，0.50至0.83]）。这种关联在既往使用者中减弱（RR，0.84[可信区间，0.67至1.05]），且在停止使用激素5年后消失（RR，0.92[可信区间，0.70至1.21]）。当前使用时间更长并未提供更大的保护作用（使用≥5年的RR，0.72[可信区间，0.53至0.96]）。即使排除报告进行过乙状结肠镜筛查的女性后，当前使用激素者患结直肠癌的相对风险仍为0.64（可信区间，0.49至0.82）。这表明这种明显的保护作用不太可能是由于激素使用者接受了更密集的筛查。当前使用者患大（≥1厘米）腺瘤的风险也低于从未使用过激素的女性（RR，0.74[可信区间，0.55至0.99]），尽管结直肠腺瘤与当前激素使用之间未发现总体上的显著关联（RR，0.91[可信区间，0.77至1.08]）。