当代激素避孕与乳腺癌风险。

Contemporary Hormonal Contraception and the Risk of Breast Cancer.

机构信息

From Rigshospitalet, the Juliane Marie Center, Department of Gynecology, University of Copenhagen, Copenhagen (L.S.M., C.W.S., Ø.L.); and Academic Primary Care (P.C.H., L.I.) and Medical Statistics (S.F.), Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.

出版信息

N Engl J Med. 2017 Dec 7;377(23):2228-2239. doi: 10.1056/NEJMoa1700732.

DOI:10.1056/NEJMoa1700732

PMID:29211679

Abstract

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.).

摘要

背景

目前对于现代激素避孕与乳腺癌风险增加之间的关系知之甚少。

方法

我们在一项全国性前瞻性队列研究中评估了激素避孕的使用与浸润性乳腺癌风险之间的关系，该研究纳入了丹麦所有年龄在 15 至 49 岁之间、无癌症或静脉血栓栓塞病史且未接受过不孕治疗的女性。全国性登记处提供了关于激素避孕使用、乳腺癌诊断和潜在混杂因素的个体更新信息。

结果

在平均随访 10.9 年（总计 1960 万人年）的 180 万名女性中，发生了 11517 例乳腺癌。与从未使用过激素避孕的女性相比，当前和近期使用激素避孕的女性乳腺癌的相对风险为 1.20（95%置信区间[CI]，1.14 至 1.26）。这种风险从使用不足 1 年的 1.09（95%CI，0.96 至 1.23）增加到使用超过 10 年的 1.38（95%CI，1.26 至 1.51）（P=0.002）。停止激素避孕后，使用激素避孕 5 年或以上的女性发生乳腺癌的风险仍高于从未使用激素避孕的女性。当前或近期使用各种口服复方（雌激素-孕激素）避孕药与风险估计值在 1.0 至 1.6 之间变化。目前或近期使用孕激素仅宫内节育器的女性发生乳腺癌的风险也高于从未使用过激素避孕的女性（相对风险，1.21；95%CI，1.11 至 1.33）。当前和近期使用任何激素避孕药的女性中，诊断出的乳腺癌绝对增加数为每 10 万人年 13 例（95%CI，10 至 16 例），即每 7690 名使用激素避孕 1 年的女性中大约增加 1 例乳腺癌。