JAMA Vol. 288 No. 3, July 17, 2002
Wird eine Hormonersatztherapie
(HET) in den Wechseljahren ausschließlich mit Östrogenen durchgeführt,
so erhöht diese Behandlung das Risiko für Eierstockkrebs
ganz erheblich. Bei der Kombinationstherapie von Östrogenen
und Gestagenen ist dies hingegen nicht der Fall.
Menopausal Hormone Replacement Therapy and Risk of Ovarian Cancer
James V. Lacey, Jr, PhD; Pamela J. Mink, PhD; Jay H. Lubin, PhD;
Mark E. Sherman, MD; Rebecca Troisi, ScD; Patricia Hartge, ScD;
Arthur Schatzkin, MD, DrPH; Catherine Schairer, PhD
Context The association between menopausal hormone replacement
therapy and ovarian cancer is unclear.
Objective To determine whether hormone replacement therapy
using estrogen only, estrogen-progestin only, or both estrogen
only and estrogen-progestin increases ovarian cancer risk.
Design A 1979-1998 cohort study of former participants
in the Breast Cancer Detection Demonstration Project, a nationwide
breast cancer screening program.
Setting Twenty-nine US clinical centers.
Participants A total of 44 241 postmenopausal women (mean
age at start of follow-up, 56.6 years).
Main Outcome Measure Incident ovarian cancer.
Results We identified 329 women who developed ovarian cancer
during follow-up. In time-dependent analyses adjusted for age,
menopause type, and oral contraceptive use, ever use of estrogen
only was significantly associated with ovarian cancer (rate ratio
[RR], 1.6; 95% confidence interval [CI], 1.2-2.0). Increasing
duration of estrogen-only use was significantly associated with
ovarian cancer: RRs for 10 to 19 years and 20 or more years were
1.8 (95% CI,
1.1-3.0) and 3.2 (95% CI, 1.7-5.7), respectively (P value for
trend <.001), and we observed a 7% (95% CI, 2%-13%) increase
in RR per year of use. We observed significantly elevated RRs
with increasing duration of estrogen-only use across all strata
of other ovarian cancer risk factors, including women with hysterectomy.
The RR for estrogen-progestin use after prior estrogen-only use
was 1.5 (95% CI, 0.91-2.4), but the RR for estrogen-progestin–only
use was 1.1 (95% CI, 0.64-1.7). The RRs for less than 2 years
and 2 or more years of estrogen-progestin–only use were 1.6 (95%
CI, 0.78-3.3) and 0.80 (95% CI, 0.35-1.8), respectively, and there
was no evidence of a
duration response (P value for trend = .30).
Conclusion Women who used estrogen-only replacement therapy,
particularly for 10 or more years, were at significantly increased
risk of ovarian cancer in this study. Women who used short-term
estrogen-progestin–only replacement therapy were not at increased
risk, but risk associated with short-term and longer-term estrogen-progestin
replacement therapy warrants further investigation.
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