《新英格兰医学杂志》2017年12月7日377:2228-2239
目前的激素避孕方法与乳腺癌风险
Lina S. Mørch, Ph.D., Charlotte W. Skovlund, M.Sc., Philip C. Hannaford, M.D., Lisa Iversen, Ph.D., Shona Fielding, Ph.D., and Øjvind Lidegaard, D.M.Sci.
N Engl J Med 2017; 377:2228-2239December 7, 2017DOI: 10.1056/NEJMoa1700732
背景
我们对目前的激素避孕与乳腺癌风险增加是否相关所知甚少。
方法
我们在一项全国性前瞻性队列研究中评价了使用激素避孕与侵袭性乳腺癌风险的相关性，这一队列研究涉及丹麦15-49岁的所有女性，这些女性为没有癌症、没有静脉血栓且未接受过不孕不育治疗。全国登记中心提供了每个人的激素避孕使用情况、乳腺癌诊断情况和可能的其它混杂因素的最新信息。
结果
在平均随访10.9年（共计随访1960万人年）的180万女性中，出现11517名乳腺癌。与从未使用过激素避孕的女性相比，所有目前和最近使用激素避孕的使用者中，乳腺癌的相对风险为1.20（95%置信区间[CI]，1.14-1.26）。激素避孕使用不足1年的这种风险为1.09（95%CI，0.96-1.23），而使用超过10年的这种风险升高到1.38（95%CI，1.26-1.51）（P=0.002）。停止使用激素避孕后，使用激素避孕≥5年的女性患乳腺癌的风险依然高于未使用过激素避孕的女性。与现在或最近使用各种口服复方（雌激素、孕激素）避孕药相关的患癌风险估测值介于1.0-1.6之间波动。现在或最近仅使用孕酮宫内避孕系统的女性患乳腺癌的风险也高于从未使用过激素避孕药的女性（相对风险，1.21；95%CI，1.11-1.33）。在现在和最近使用激素避孕药的使用者中，诊断出乳腺癌总的绝对增加数为13名/10万人年（95%CI，10-16），每7690名使用激素避孕药1年的女性大约会多1例乳腺癌。
结论
在现在和最近使用激素避孕的女性中，患乳腺癌的风险高于从未使用过激素避孕的女性，且随着使用激素避孕时间的延长，这种风险增加，但风险增加的绝对值不大。
Contemporary Hormonal Contraception and the Risk of Breast Cancer
Lina S. Mørch, Ph.D., Charlotte W. Skovlund, M.Sc., Philip C. Hannaford, M.D., Lisa Iversen, Ph.D., Shona Fielding, Ph.D., and Øjvind Lidegaard, D.M.Sci.
N Engl J Med 2017; 377:2228-2239December 7, 2017DOI: 10.1056/NEJMoa1700732
Background
Little is known about whether contemporary hormonal contraception is associated with an increased risk of breast cancer.
Methods
We assessed associations between the use of hormonal contraception and the risk of invasive breast cancer in a nationwide prospective cohort study involving all women in Denmark between 15 and 49 years of age who had not had cancer or venous thromboembolism and who had not received treatment for infertility. Nationwide registries provided individually updated information about the use of hormonal contraception, breast-cancer diagnoses, and potential confounders.
Results
Among 1.8 million women who were followed on average for 10.9 years (a total of 19.6 million person-years), 11,517 cases of breast cancer occurred. As compared with women who had never used hormonal contraception, the relative risk of breast cancer among all current and recent users of hormonal contraception was 1.20 (95% confidence interval [CI], 1.14 to 1.26). This risk increased from 1.09 (95% CI, 0.96 to 1.23) with less than 1 year of use to 1.38 (95% CI, 1.26 to 1.51) with more than 10 years of use (P=0.002). After discontinuation of hormonal contraception, the risk of breast cancer was still higher among the women who had used hormonal contraceptives for 5 years or more than among women who had not used hormonal contraceptives. Risk estimates associated with current or recent use of various oral combination (estrogen–progestin) contraceptives varied between 1.0 and 1.6. Women who currently or recently used the progestin-only intrauterine system also had a higher risk of breast cancer than women who had never used hormonal contraceptives (relative risk, 1.21; 95% CI, 1.11 to 1.33). The overall absolute increase in breast cancers diagnosed among current and recent users of any hormonal contraceptive was 13 (95% CI, 10 to 16) per 100,000 person-years, or approximately 1 extra breast cancer for every 7690 women using hormonal contraception for 1 year.
Conclusions
The risk of breast cancer was higher among women who currently or recently used contemporary hormonal contraceptives than among women who had never used hormonal contraceptives, and this risk increased with longer durations of use; however, absolute increases in risk were small. (Funded by the Novo Nordisk Foundation.)
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