雌激素,孕激素和乳腺癌的风险。

M C Pike, A H Wu, D V Spicer, S Lee, C L Pearce
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引用次数: 17

摘要

肥胖与绝经前妇女患乳腺癌的风险降低有关,但与绝经后妇女患乳腺癌的风险增加有关,这种影响随着绝经后的时间而增加。对肥胖的这些影响的分析表明,雌激素对乳房的致癌作用有一个上限;非性激素结合的球蛋白结合的雌二醇(非shbg结合的E2)超过约10.2 pg/ml对乳腺癌风险没有进一步的影响;这个上限低于月经周期的最低水平。这表明绝经期雌激素治疗(ET)和绝经期雌激素-黄体酮治疗(EPT)对女性乳腺癌风险的影响将在很大程度上取决于她的体重指数(BMI;体重单位为公斤/身高单位为米的平方(kg/m2),对苗条女性的影响最大。流行病学研究证实了这一预测。我们的最佳估计是,每使用5年,雌激素对乳腺癌风险的影响是BMI为20 kg/m2的女性增加30%,而BMI为30 kg/m2的女性增加8%;EPT的等效数字为50%和26%。对雌激素影响的分析还表明,即使将雌激素在ET和EPT中的剂量减少一半,对这些风险的影响也很小或没有影响。减少黄体酮的剂量可能会显著降低EPT的风险:这可能与子宫内膜给药途径。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Estrogens, progestins, and risk of breast cancer.

Obesity is associated with a decreased risk of breast cancer in premenopausal women but an increased risk in postmenopausal women, an effect that increases with time since menopause. Analysis of these effects of obesity shows that there is a ceiling to the carcinogenic effect of estrogen on the breast; increases in nonsex hormone-binding globulin-bound estradiol (non-SHBG bound E2) exceeding approximately 10.2 pg/ml have no further effect on breast cancer risk; this ceiling is lower than the lowest level seen during the menstrual cycle. This suggests that the effects of menopausal estrogen therapy (ET) and menopausal estrogen-progestin therapy (EPT) on a woman's breast cancer risk will greatly depend on her body mass index (BMI; weight in kilograms/height in meters squared, kg/m2) with the largest effects being in slender women. Epidemiological studies confirm this prediction. Our best estimates, per 5 years of use, of the effects of ET on breast cancer risk is a 30% increase in a woman with a BMI of 20 kg/m2 decreasing to an 8% increase in a woman with a BMI of 30 kg/m2; the equivalent figures for EPT are 50% and 26%. The analysis of the effects of estrogen also shows that even reducing the dose of estrogen in ET and EPT by as much as a half will have little or no effect on these risks. Reducing the progestin dose is likely to significantly reduce the risk of EPT: this is possible with an endometrial route of administration.

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