推 cupidvenus:我還有30頁原文word (哭 01/11 16:29
Progestin比Estrogen更容易引發乳癌
http://www.24drs.com/professional/list/content.asp?x_classno=8&x_idno=2300
作者：Laurie Barclay, MD
出處：WebMD醫學新聞
審閱：Gary D. Vogin, MD
March 5, 2003 - 3月15日的「癌症（Cancer）」期刊報導，
根據一項世代研究結果顯示，Progestin比estrogen更容易引起
乳癌，這與去年12月15日「癌症（Cancer）」期刊所報導的另一
篇病例控制的對照研究（case-control study）結果一致。
瑞典Lund大學附設醫院Hakan L. Olsson博士表示，這些結果
可協助醫師更適當地處方荷爾蒙取代療法（HRT），以避免乳癌
的發生。
在1990 ~ 1992年間，研究人員從40,000名25 ~ 65歲、未曾
罹患任何癌症的婦女中隨機選取29,508名受試者，追蹤到2001年
12月產生了一個298,649人年的世代，其中共有556個乳癌病例，
這比預期的數目稍微高了一些（標準化的患病率為1.09；95%信
賴區間，1.00 - 1.19），大約3,663名婦女曾經採用荷爾蒙取代
療法（HRT）。
與未曾使用荷爾蒙取代療法（HRT）的婦女比較，採用含Progestin
荷爾蒙取代療法（HRT）的婦女可能會增加罹患乳癌的風險。持
續採用含Progestin荷爾蒙取代療法（HRT）者會增加4.6倍的乳
癌風險（95%信賴區間，2.39 - 8.84），間斷採用含Progestin
荷爾蒙取代療法（HRT）者會增加2.2倍的乳癌風險（無意義，95%
信賴區間，0.80 - 5.56），單獨使用estrogen荷爾蒙取代療法
（HRT）會增加1.89倍的乳癌風險（無意義，95%信賴區間，0.81
- 4.39），5年後停止使用荷爾蒙取代療法（HRT）不會增加乳癌
的風險。
以含有Progestin的荷爾蒙取代療法（HRT）持續治療48個月以
上會加倍罹患乳癌的風險，而且是各種HRT療法中風險最高的，估
計一位以含有Progestin的荷爾蒙取代療法（HRT）持續治療48個
月以上的50歲婦女，其累計的乳癌風險將比乳癌患者的一級親友
還要高出3倍之多（7%；95%信賴區間，5.4% - 11.4%），而未曾
使用HRT療法的婦女，其罹患乳癌的風險僅有2%（95%信賴區間，
1.6% - 2.9%），長期使用progestin的婦女，每年罹患乳癌的風
險大約為BRCA1基因突變者的一半。
結果顯示，僅提供estrogen的荷爾蒙取代療法（HRT）相對較
為安全，較不易引起乳癌的危險，持續性地服用progestin比間
斷地服用progestin，風險更大。
由於研究人員可能會低估HRT的療效，因此他們建議未來能再
進行前瞻性、隨機的長期世代研究。
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
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(整理文獻中
正在寫一篇性別與醫療-以ts和HRT為例 的論文)
唉..,
有天然的多好..
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