Progestin比Estrogen更容易引发乳癌 http://www.24drs.com/professional/list/content.asp?x_classno=8&x_idno=2300 作者：Laurie Barclay, MD 出处：WebMD医学新闻 审阅：Gary D. Vogin, MD 　March 5, 2003 - 3月15日的「癌症（Cancer）」期刊报导， 根据一项世代研究结果显示，Progestin比estrogen更容易引起 乳癌，这与去年12月15日「癌症（Cancer）」期刊所报导的另一 篇病例控制的对照研究（case-control study）结果一致。 　　 　瑞典Lund大学附设医院Hakan L. Olsson博士表示，这些结果 可协助医师更适当地处方荷尔蒙取代疗法（HRT），以避免乳癌 的发生。 　　 　在1990 ~ 1992年间，研究人员从40,000名25 ~ 65岁、未曾 罹患任何癌症的妇女中随机选取29,508名受试者，追踪到2001年 12月产生了一个298,649人年的世代，其中共有556个乳癌病例， 这比预期的数目稍微高了一些（标准化的患病率为1.09；95%信 赖区间，1.00 - 1.19），大约3,663名妇女曾经采用荷尔蒙取代 疗法（HRT）。 　　 　与未曾使用荷尔蒙取代疗法（HRT）的妇女比较，采用含Progestin 荷尔蒙取代疗法（HRT）的妇女可能会增加罹患乳癌的风险。持 续采用含Progestin荷尔蒙取代疗法（HRT）者会增加4.6倍的乳 癌风险（95%信赖区间，2.39 - 8.84），间断采用含Progestin 荷尔蒙取代疗法（HRT）者会增加2.2倍的乳癌风险（无意义，95% 信赖区间，0.80 - 5.56），单独使用estrogen荷尔蒙取代疗法 （HRT）会增加1.89倍的乳癌风险（无意义，95%信赖区间，0.81 - 4.39），5年後停止使用荷尔蒙取代疗法（HRT）不会增加乳癌 的风险。 　　 　以含有Progestin的荷尔蒙取代疗法（HRT）持续治疗48个月以 上会加倍罹患乳癌的风险，而且是各种HRT疗法中风险最高的，估 计一位以含有Progestin的荷尔蒙取代疗法（HRT）持续治疗48个 月以上的50岁妇女，其累计的乳癌风险将比乳癌患者的一级亲友 还要高出3倍之多（7%；95%信赖区间，5.4% - 11.4%），而未曾 使用HRT疗法的妇女，其罹患乳癌的风险仅有2%（95%信赖区间， 1.6% - 2.9%），长期使用progestin的妇女，每年罹患乳癌的风 险大约为BRCA1基因突变者的一半。 　　 　结果显示，仅提供estrogen的荷尔蒙取代疗法（HRT）相对较 为安全，较不易引起乳癌的危险，持续性地服用progestin比间 断地服用progestin，风险更大。 　　 　由於研究人员可能会低估HRT的疗效，因此他们建议未来能再 进行前瞻性、随机的长期世代研究。 Progestin Increases Breast Can By Laurie Barclay, MD Medscape Medical News March 5, 2003 — Progestin is associated with greater risk of breast cancer than is estrogen, according to the results of a cohort study published in the March 15 issue of Cancer. This finding is consistent with that of a case-control study reported in the Dec. 15 issue of Cancer. "These results may help physicians to better tailor [hormone replacement] therapy (HRT) to avoid breast carcinoma," write Hakan L. Olsson, MD, PhD, from the University Hospital in Lund, Sweden, and colleagues. From 1990 to 1992, the investigators enrolled 29,508 randomly selected subjects from a population of 40,000 women between the ages of 25 and 65 years with no prior history of cancer. Follow-up through December 2001 yielded a cohort of 298,649 person-years, and 556 cases of breast cancer, which was slightly higher than expected (standardized morbidity ratio, 1.09; 95% confidence interval [CI], 1.00 - 1.19). Approximately 3,663 women had a history of HRT use. Progestin-containing HRT was associated with the highest risk of breast cancer. Compared with women who never used HRT, risk of breast cancer was increased 4.6-fold for combined continuous HRT (95% CI, 2.39 - 8.84), 2.2-fold for combined-sequential HRT (not significant; 95% CI, 0.80 - 5.56) and 1.89-fold for estrogen-only HRT with estriol (not significant; 95% CI, 0.81 - 4.39). Five years after stopping HRT use, there was no increased risk. Combined-continuous HRT used for at least 48 months more than doubled breast cancer risk, and it increased risk of breast cancer more than any other HRT regimen. Estimated cumulative risk for a 50-year-old woman using combined-continuous therapy for at least 48 months was more than three times greater than that for a woman with a first-degree relative with breast cancer (7%; 95% CI, 5.4% - 11.4%), compared with a risk for never-users of 2% (95% CI, 1.6% - 2.9%). For long-term users of progestins, the yearly risk of breast cancer is approximately half the risk of a BRCA1 mutation carrier. Because of study limitations including potential underestimation of the effects of HRT, the authors recommend prospective cohort investigations with longer follow-up and randomized trials. "These data suggest that estrogen-only therapy is a rather safe therapy with little breast carcinoma risk," the authors write. "Continuous administration of progestins is more hazardous than sequential administration." Cancer. 2003;97(6):1387-1392 Reviewed by Gary D. Vogin, MD -- (整理文献中 正在写一篇性别与医疗-以ts和HRT为例 的论文) 唉.., 有天然的多好.. --

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