目的:探讨更年期激素治疗(MHT)相关乳腺癌的风险,包括今天使用的各种孕激素。
方法:该研究包括来自韩国国家健康保险数据库(2011-2014)的40岁以上的绝经后妇女,她们使用MHT超过6个月(MHT组)或从未使用过MHT(非MHT组),并根据倾向评分匹配的几个变量进行1:1匹配。两组都被跟踪到2020年。
结果:非MHT组和MHT组各包括153736名女性。在具有时间依赖协变量的Cox比例风险分析中,MHT与乳腺癌风险增加相关(风险比[HR]1.22,95%置信区间[CI]1.15-1.3)。Tibolone,戊酸雌二醇(EV)/醋酸甲羟孕酮(MPA),EV/醋酸炔诺酮(NETA),共轭马雌激素(CEE),EV,雌二醇半水合物(EH),CEE/微粉化孕酮(MP),CEE/MPA,EV/MP,EV/MPA,与非MHT组相比,EH/MP未增加患乳腺癌的风险。然而,EH/屈螺酮(DRSP)(HR1.51,95%CI1.38-1.66),EH/NETA(HR1.66,95%CI1.34-2.06),EH/地屈孕酮(DYD)(HR1.37,95%CI1.12-1.68),与非MHT组相比,EV/醋酸环丙孕酮(CPA)(HR1.74,95%CI1.54-1.96)增加了患乳腺癌的风险。
结论:MHT与乳腺癌风险增加有关,但不是所有的MHTs。特定的联合疗法(EH/DRSP,EH/DYD,EH/NETA,和EV/CPA)与较高的风险相关,而单独的雌激素和替勃龙则没有。
OBJECTIVE: To explore the risk of breast cancer associated with menopausal hormone therapy (MHT), including the various progestogens used today.
METHODS: The study included postmenopausal women over 40 years from the National Health Insurance Database in South Korea (2011-2014) who either used MHT for over 6 months (MHT group) or never used MHT (non-MHT group) and were matched 1:1 based on several variables using propensity score matching. Both groups were followed until 2020.
RESULTS: The non-MHT and MHT groups comprised 153 736 women each. In Cox proportional hazard analysis with time-dependent covariates, MHT was associated with an increased risk of breast cancer (hazard ratio [HR] 1.22, 95% confidence interval [CI] 1.15-1.3). Tibolone, estradiol valerate (EV)/medroxyprogesterone acetate (MPA), EV/norethisterone acetate (NETA), conjugated equine estrogen (CEE), EV, estradiol hemihydrate (EH), CEE/micronized progesterone (MP), CEE/MPA, EV/MP, EV/MPA, and EH/MP did not increase the risk of breast cancer compared with the non-MHT group. However, EH/drospirenone (DRSP) (HR 1.51, 95% CI 1.38-1.66), EH/NETA (HR 1.66, 95% CI 1.34-2.06), EH/dydrogesterone (DYD) (HR 1.37, 95% CI 1.12-1.68), and EV/cyproterone acetate (CPA) (HR 1.74, 95% CI 1.54-1.96) increased the risk of breast cancer compared with the non-MHT group.
CONCLUSIONS: MHT was linked to increased breast cancer risk, but not all MHTs. Specific combined therapies (EH/DRSP, EH/DYD, EH/NETA, and EV/CPA) were associated with higher risk, whereas estrogen alone and tibolone were not.