據(jù)7月15日刊JAMA上的一則研究披露,，與那些從來沒有接受過激素治療的婦女相比,，那些現(xiàn)在正在服用激素或是在過去曾經(jīng)服用過激素的婦女，其罹患卵巢癌的風險會增加,，這種風險的增加與激素使用的時間長短,、制劑配方、雌激素劑量,、治療方式以及給藥途徑無關(guān),。
對卵巢癌的原發(fā)性預(yù)防是富有挑戰(zhàn)性的，因為人們對其發(fā)病原因所知甚少,。根據(jù)文章的背景資料,，有研究表明，那些接受絕經(jīng)后激素治療（HT）的婦女,，其罹患卵巢癌的風險會增加,。有關(guān)激素配方、治療方法以及給藥途徑所造成的不同影響的數(shù)據(jù)十分有限,。
Rigshospitalet, Copenhagen University, Denmark的Lina Steinrud M?rch, M.Sc.及其同僚開展了一項研究,，旨在對與激素療法的使用與卵巢癌風險之間的關(guān)聯(lián)進行調(diào)查,。該項研究通過與丹麥國家登記記錄掛鉤而納入的研究對象包括從1995年到2005年期間所有的年齡在50-79歲之間的丹麥婦女。來自National Register of Medicinal Product Statistics的處方藥數(shù)據(jù)提供給研究人員有關(guān)HT使用的最新的個人資料,。National Cancer Register和Pathology Register則提供給研究人員有關(guān)卵巢癌發(fā)病率的數(shù)據(jù),。這項分析中一共包括90萬9946名沒有罹患對激素敏感的癌癥或是那些沒有摘除雙側(cè)卵巢的婦女。在隨訪結(jié)束的時候,，有63%的婦女沒有接受過HT,，有22%的婦女在過去服用過激素，有9%的婦女是現(xiàn)今的激素服用者,。在激素的現(xiàn)今服用者中,，有46%的人服用激素的時間在7年以上。
在為期平均8年的隨訪中,，有3068人發(fā)現(xiàn)患有卵巢癌,。在這些患者中，有2681人所罹患的是上皮性腫瘤（這是卵巢癌中的一種）,。與從來沒有服用過激素者相比,，那些現(xiàn)行接受HT的婦女，其罹患卵巢癌的總體風險增加了38%,。如果僅分析上皮性卵巢癌的發(fā)病率,，與從來沒有接受過HT的人相比，現(xiàn)行接受HT的人的相對風險增加了44%,，而先前接受過HT的人的風險則增加了15%,。卵巢癌及上皮性卵巢癌的風險沒有因為接受HT的時間增加而有顯著的增加。
罹患卵巢癌的風險會隨著與最后接受HT治療的時間的延長而下降,。罹患卵巢癌的風險不會因為制劑的配方,、治療計劃、孕酮的類型或給藥途徑而呈現(xiàn)顯著的差別,。
罹患卵巢癌的絕對風險表明,，在每年服用激素的婦女中，大約每8300人中罹患卵巢癌者可能會多增加一人,。文章的作者寫道：“如果這種關(guān)聯(lián)是因國關(guān)系的話,，那么，服用激素在平均8年的隨訪期中已經(jīng)導(dǎo)致了在丹麥大約140例的卵巢癌病例的增加,，即,，占本研究中的5%的卵巢癌病例。即使這一比率看來很低,，但卵巢癌仍然是一種高度致命的腫瘤,，因而，在決定是否應(yīng)給予病人HT的時候這種風險仍然應(yīng)該被考慮,。”（生物谷Bioon.com）
生物谷推薦原始出處：
JAMA. 2009;302(3):298-305.
Hormone Therapy and Ovarian Cancer
Lina Steinrud M?rch, MSc; Ellen L?kkegaard, MD, PhD; Anne Helms Andreasen, MSc; Susanne Krüger-Kj?r, MD, DrMSci; ?jvind Lidegaard, MD, DrMSci
Context Studies have suggested an increased risk of ovarian cancer among women taking postmenopausal hormone therapy. Data are sparse on the differential effects of formulations, regimens, and routes of administration.
Objective To assess risk of ovarian cancer in perimenopausal and postmenopausal women receiving different hormone therapies.
Design and Setting Nationwide prospective cohort study including all Danish women aged 50 through 79 years from 1995 through 2005 through individual linkage to Danish national registers. Redeemed prescription data from the National Register of Medicinal Product Statistics provided individually updated exposure information. The National Cancer Register and Pathology Register provided ovarian cancer incidence data. Information on confounding factors and effect modifiers was from other national registers. Poisson regression analyses with 5-year age bands included hormone exposures as time-dependent covariates.
Participants A total of 909 946 women without hormone-sensitive cancer or bilateral oophorectomy.
Main Outcome Measure Ovarian cancer.
Results In an average of 8.0 years of follow-up (7.3 million women-years), 3068 incident ovarian cancers, of which 2681 were epithelial cancers, were detected. Compared with women who never took hormone therapy, current users of hormones had incidence rate ratios for all ovarian cancers of 1.38 (95% confidence interval [CI], 1.26-1.51) and 1.44 (95% CI, 1.30-1.58) for epithelial ovarian cancer. The risk declined with years since last use: 0 to 2 years, 1.22 (95% CI, 1.02-1.46); more than 2 to 4 years, 0.98 (95% CI, 0.75-1.28); more than 4 to 6 years, 0.72 (95% CI, 0.50-1.05), and more than 6 years, 0.63 (95% CI, 0.41-0.96). For current users the risk of ovarian cancer did not differ significantly with different hormone therapies or duration of use. The incidence rates in current and never users of hormones were 0.52 and 0.40 per 1000 years, respectively, ie, an absolute risk increase of 0.12 (95% CI, 0.01-0.17) per 1000 years. This approximates 1 extra ovarian cancer for roughly 8300 women taking hormone therapy each year.
Conclusion Regardless of the duration of use, the formulation, estrogen dose, regimen, progestin type, and route of administration, hormone therapy was associated with an increased risk of ovarian cancer.
