JNCI：荷尔蒙联合治疗或导致乳腺癌风险增加

洛杉矶生物医学研究所首席研究员、医学博士Rowan Chlebowski博士，在《美国国家癌症研究》杂志上发表了一项研究成果，该项研究是妇女健康提倡协会进行的针对妇女绝经后的激素替代疗法的有史以来最大的研究，以下内容是文章中发表的最新发现。

Chlebowski博士撰写的研究报告称，雌激素与孕激素的联合应用与妇女乳腺癌发病率增加有关。此外，研究还称，对于女性乳腺癌患者，接受荷尔蒙联合治疗者与两种荷尔蒙都没有使用者相比，两者的预后类似。由此可以说明，使用荷尔蒙联合治疗的妇女，不仅其乳腺癌发病率更高，而且因乳腺癌导致的死亡率也可能会更高。

“这项研究表明，临近围绝经期才开始进行雌激素与孕激素联合治疗的妇女，其患乳腺癌的风险要比更早开始接受荷尔蒙联合治疗的妇女更高。这一发现具有非常重要的价值，因为通常来讲，女性因为临近围绝经期才同意接受荷尔蒙治疗。

“这项研究还表明，在接受雌激素与孕激素联合治疗的妇女中，不只是那些预后良好的乳腺癌，所有类型的乳腺癌发病率均有增加。这一发现意味着接受这种荷尔蒙联合治疗的妇女，其因乳腺癌导致的死亡率更高。像往常一样，在接受任何荷尔蒙疗法来帮助缓解围绝经期症状前，妇女都先应该咨询医生，并考虑其中存在的潜在风险。”（生物谷Bioon.com）

doi:10.1093/jnci/djt043
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Estrogen Plus Progestin and Breast Cancer Incidence and Mortality in the Women's Health Initiative Observational Study

Chlebowski RT Manson JE Anderson GL Cauley JA Aragaki AK Stefanick ML Lane DS Johnson KC Wactawski-Wende J Chen C Qi L Yasmeen S Newcomb PA Prentice RL

In the Women's Health Initiative (WHI) randomized trial, estrogen plus progestin increased both breast cancer incidence and mortality. In contrast, most observational studies associate estrogen plus progestin with favorable prognosis breast cancers. To address differences, a cohort of WHI observational study participants with characteristics similar to the WHI clinical trial was studied.MethodsWe identified 41 449 postmenopausal women with no prior hysterectomy and mammogram negative within 2 years who were either not hormone users (n = 25 328) or estrogen and progestin users (n = 16 121). Multivariable-adjusted Cox proportional hazard regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CI). All statistical tests were two-sided.ResultsAfter a mean of 11.3 (SD = 3.1) years, with 2236 breast cancers, incidence was higher in estrogen plus progestin users than in nonusers (0.60% vs 0.42%, annualized rate, respectively; HR = 1.55, 95% CI = 1.41 to 1.70, P < .001). Women initiating hormone therapy closer to menopause had higher breast cancer risk with linear diminishing influence as time from menopause increased (P < .001). Survival after breast cancer, measured from diagnosis, was similar in combined hormone therapy users and nonusers (HR = 1.03, 95% CI = 0.79 to 1.35). On a population basis, there were somewhat more deaths from breast cancer, measured from cohort entry (HR = 1.32, 95% CI = 0.90 to 1.93, P = .15), and more all-cause deaths after breast cancer (HR = 1.65, 95% CI = 1.29 to 2.12, P < .001) in estrogen plus progestin users than in nonusers.ConclusionsConsistent with WHI randomized trial findings, estrogen plus progestin use is associated with increased breast cancer incidence. Because prognosis after diagnosis on combined hormone therapy is similar to that of nonusers, increased breast cancer mortality can be expected.

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