Catherine Huntley, Bethany Torr, Grace Kavanaugh, Angela George, Helen Hanson, Katie Snape, John Broggio, Louise Glasgow, Marc Tischkowitz, D Gareth Evans, Antonis C Antoniou, Clare Turnbull
{"title":"对有乳腺癌家族史的妇女进行乳腺癌风险评估，以便为其开具绝经激素治疗处方。","authors":"Catherine Huntley, Bethany Torr, Grace Kavanaugh, Angela George, Helen Hanson, Katie Snape, John Broggio, Louise Glasgow, Marc Tischkowitz, D Gareth Evans, Antonis C Antoniou, Clare Turnbull","doi":"10.3399/BJGP.2023.0327","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Menopausal hormone therapy (MHT) can alleviate menopausal symptoms but has been associated with an increased risk of breast cancer. MHT prescription should be preceded by individualised risk/benefit evaluation; however, data outlining the impact of family history alongside different MHT therapeutic approaches are lacking.</p><p><strong>Aim: </strong>To quantify the risks associated with MHT use in women with varying breast cancer family histories of developing and dying from breast cancer.</p><p><strong>Design and setting: </strong>An epidemiological modelling study for women in England using the BOADICEA breast cancer prediction model and data relating to MHT use and breast cancer risk taken from research by the Collaborative Group on Hormonal Factors in Breast Cancer.</p><p><strong>Method: </strong>The risk of developing and dying from breast cancer between the ages of 50 and 80 years was modelled in women with four different breast cancer family history profiles: 'average', 'modest', 'intermediate', and 'strong' by using 1) background risks of breast cancer by age and family history, 2) relative risks for breast cancer associated with MHT use, and 3) 10-year breast cancer-specific net mortality rates. This study modelled use of combined oestrogen-progestogen MHT (cyclical or continuous) and oestrogen-only MHT.</p><p><strong>Results: </strong>For a woman of 'average' family history taking no MHT, the cumulative breast cancer risk (age 50-80 years) is 9.8%, and the risk of dying from the breast cancer is 1.7%. In this model, 5 years' exposure to combined-cyclical MHT (age 50-55 years) was calculated to increase these risks to 11.0% and 1.8%, respectively. For a woman with a 'strong' family history taking no MHT, the cumulative breast cancer risk is 19.6% (age 50-80 years), and the risk of dying from the breast cancer is 3.2%. With 5 years' exposure to MHT (age 50-55 years), this model showed that these risks increase to 22.4% and 3.5%, respectively.</p><p><strong>Conclusion: </strong>In this model, both family history and MHT are associated with increased risk of breast cancer. Estimates of the risks of breast cancer associated with MHT for women with different family histories can be used to support decision making around MHT prescription for women experiencing menopausal symptoms.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e610-e618"},"PeriodicalIF":5.3000,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11257066/pdf/","citationCount":"0","resultStr":"{\"title\":\"Breast cancer risk assessment for prescription of menopausal hormone therapy in women with a family history of breast cancer: an epidemiological modelling study.\",\"authors\":\"Catherine Huntley, Bethany Torr, Grace Kavanaugh, Angela George, Helen Hanson, Katie Snape, John Broggio, Louise Glasgow, Marc Tischkowitz, D Gareth Evans, Antonis C Antoniou, Clare Turnbull\",\"doi\":\"10.3399/BJGP.2023.0327\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Menopausal hormone therapy (MHT) can alleviate menopausal symptoms but has been associated with an increased risk of breast cancer. MHT prescription should be preceded by individualised risk/benefit evaluation; however, data outlining the impact of family history alongside different MHT therapeutic approaches are lacking.</p><p><strong>Aim: </strong>To quantify the risks associated with MHT use in women with varying breast cancer family histories of developing and dying from breast cancer.</p><p><strong>Design and setting: </strong>An epidemiological modelling study for women in England using the BOADICEA breast cancer prediction model and data relating to MHT use and breast cancer risk taken from research by the Collaborative Group on Hormonal Factors in Breast Cancer.</p><p><strong>Method: </strong>The risk of developing and dying from breast cancer between the ages of 50 and 80 years was modelled in women with four different breast cancer family history profiles: 'average', 'modest', 'intermediate', and 'strong' by using 1) background risks of breast cancer by age and family history, 2) relative risks for breast cancer associated with MHT use, and 3) 10-year breast cancer-specific net mortality rates. This study modelled use of combined oestrogen-progestogen MHT (cyclical or continuous) and oestrogen-only MHT.</p><p><strong>Results: </strong>For a woman of 'average' family history taking no MHT, the cumulative breast cancer risk (age 50-80 years) is 9.8%, and the risk of dying from the breast cancer is 1.7%. In this model, 5 years' exposure to combined-cyclical MHT (age 50-55 years) was calculated to increase these risks to 11.0% and 1.8%, respectively. For a woman with a 'strong' family history taking no MHT, the cumulative breast cancer risk is 19.6% (age 50-80 years), and the risk of dying from the breast cancer is 3.2%. With 5 years' exposure to MHT (age 50-55 years), this model showed that these risks increase to 22.4% and 3.5%, respectively.</p><p><strong>Conclusion: </strong>In this model, both family history and MHT are associated with increased risk of breast cancer. 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引用次数: 0
摘要
背景绝经期激素疗法（MHT）可减轻绝经期症状，但与乳腺癌（BC）风险增加有关。在开具更年期激素治疗处方之前，应进行个体化的风险/效益评估；然而，目前还缺乏有关家族史对不同更年期激素治疗方法的影响的数据。目的 对有不同乳腺癌家族史的妇女使用 MHT 的相关风险进行量化，这些妇女 i) 可能患上乳腺癌，ii) 可能死于乳腺癌。设计与环境 一项流行病学模型研究（英国女性）。方法 我们使用 i）按年龄和家族史分列的 BC 背景风险；ii）与使用 MHT 相关的 BC 相对风险；iii）10 年 BC 特异性净死亡率来模拟具有四种不同 BC 家族史的妇女在 50 至 80 岁期间患 BC 和死于 BC 的风险：一般"、"一般"、"中等 "和 "较强"。结果 对于没有服用 MHT 的具有 "一般 "家族史的妇女来说，累积的 BC 风险（50-80 岁）为 9.8%，死于 BC 的风险为 1.7%。接受联合周期性 MHT 五年后（50-55 岁），上述风险分别增加到 11.0% 和 1.8%。对于有 "强 "家族史且未接受过任何 MHT 的妇女，累积 BC 风险为 19.6%，死亡风险为 3.2%。如果进行 5 年的中期保健治疗（50-55 岁），这一比例将分别增加到 22.4% 和 3.5%。结论 家族史和 MHT 都与 BC 风险增加有关。对有不同家族史的女性进行MHT相关风险的估计，可为MHT处方的决策提供支持。
Breast cancer risk assessment for prescription of menopausal hormone therapy in women with a family history of breast cancer: an epidemiological modelling study.
Background: Menopausal hormone therapy (MHT) can alleviate menopausal symptoms but has been associated with an increased risk of breast cancer. MHT prescription should be preceded by individualised risk/benefit evaluation; however, data outlining the impact of family history alongside different MHT therapeutic approaches are lacking.
Aim: To quantify the risks associated with MHT use in women with varying breast cancer family histories of developing and dying from breast cancer.
Design and setting: An epidemiological modelling study for women in England using the BOADICEA breast cancer prediction model and data relating to MHT use and breast cancer risk taken from research by the Collaborative Group on Hormonal Factors in Breast Cancer.
Method: The risk of developing and dying from breast cancer between the ages of 50 and 80 years was modelled in women with four different breast cancer family history profiles: 'average', 'modest', 'intermediate', and 'strong' by using 1) background risks of breast cancer by age and family history, 2) relative risks for breast cancer associated with MHT use, and 3) 10-year breast cancer-specific net mortality rates. This study modelled use of combined oestrogen-progestogen MHT (cyclical or continuous) and oestrogen-only MHT.
Results: For a woman of 'average' family history taking no MHT, the cumulative breast cancer risk (age 50-80 years) is 9.8%, and the risk of dying from the breast cancer is 1.7%. In this model, 5 years' exposure to combined-cyclical MHT (age 50-55 years) was calculated to increase these risks to 11.0% and 1.8%, respectively. For a woman with a 'strong' family history taking no MHT, the cumulative breast cancer risk is 19.6% (age 50-80 years), and the risk of dying from the breast cancer is 3.2%. With 5 years' exposure to MHT (age 50-55 years), this model showed that these risks increase to 22.4% and 3.5%, respectively.
Conclusion: In this model, both family history and MHT are associated with increased risk of breast cancer. Estimates of the risks of breast cancer associated with MHT for women with different family histories can be used to support decision making around MHT prescription for women experiencing menopausal symptoms.
期刊介绍：
The British Journal of General Practice is an international journal publishing research, editorials, debate and analysis, and clinical guidance for family practitioners and primary care researchers worldwide.
BJGP began in 1953 as the ‘College of General Practitioners’ Research Newsletter’, with the ‘Journal of the College of General Practitioners’ first appearing in 1960. Following the change in status of the College, the ‘Journal of the Royal College of General Practitioners’ was launched in 1967. Three editors later, in 1990, the title was changed to the ‘British Journal of General Practice’. The journal is commonly referred to as the ''BJGP'', and is an editorially-independent publication of the Royal College of General Practitioners.
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