徐颖;林燕;王常珺;孙强;
XU Ying;LIN Yan;WANG Chang-jun;SUN Qiang;Department of Breast Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

• 1:中国医学科学院北京协和医学院北京协和医院乳腺外科

摘要(Abstract)：

绝经激素治疗(menopausal hormone therapy,MHT)是以雌激素补充为核心的治疗,在有子宫的女性治疗中往往需联合雌激素和孕激素。妇科内分泌和乳腺外科专家就围绝经期MHT是否增加乳腺癌风险展开讨论并达成共识:MHT可增加乳腺癌风险,应用时需全面评估风险与收益;MHT存在用药窗口期、用药指征、禁忌证,应用前需告知患者相关风险并取得知情同意。对天然孕激素、替勃龙及单雌激素治疗是否增加乳腺癌发生风险等问题仍存在争议。
Menopausal hormone therapy( MHT) is the medical treatment that mitigates menopausal symptoms with administration of supplementary sexual hormones. Estrogen and progesterone are often involved in MHT.Experts from the Department of Gynecologic Endocrine and the Department of Breast Surgery have paid special attention to the risk of breast carcinoma related to MHT and reached consensuses on the following issues: MHT increases the risk of breast carcinoma; decision should be made after a careful and comprehensive assessment of the risk of breast carcinoma and the potential benefit of MHT. Since the administration of MHT has a window period,a thorough discussion with patients is essential to fully inform the indication and contraindication of MHT,and an informed consent should be obtained. There are still controversies over the risk of breast carcinoma with natural progesterone,tibolone,and single estrogen.

关键词(KeyWords)： 绝经激素治疗;乳腺癌;风险
menopausal hormone therapy;breast carcinoma;risk

Abstract:

Keywords:

基金项目(Foundation):

作者(Authors): 徐颖;林燕;王常珺;孙强;
XU Ying;LIN Yan;WANG Chang-jun;SUN Qiang;Department of Breast Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

参考文献(References)：

• [1]Torre LA,Bray F,Siegel RL,et al.Global cancer statistics,2012[J].CA Cancer J Clin,2015,65:87-108.
• [2]Chen W,Zheng R,Baade PD,et al.Cancer statistics in China,2015[J].CA Cancer J Clin,2016,66:115-132.
• [3]Fan L,Strasser-Weippl K,Li JJ,et al.Breast cancer in China[J].Lancet Oncol,2014,15:e279-e289.
• [4]Rossouw JE,Anderson GL,Prentice RL,et al.Risks and benefits of estrogen plus progestin in healthy postmenopausal women:principal results from the Women's Health Initiative randomized controlled trial[J].JAMA,2002,288:321-333.
• [5]Chlebowski RT,Rohan TE,Manson JE,et al.Breast Cancer After Use of Estrogen Plus Progestin and Estrogen Alone:Analyses of Data From 2 Women's Health Initiative Randomized Clinical Trials[J].JAMA Oncol,2015,1:296-305.
• [6]Jo Ann E,Manson PH,Rowan T,et al.The Women's Health Initiative Hormone Therapy Trials:Update and Overview of Health Outcomes During the intervention and Poststopping Phases[J].JAMA,2013,301:1353-1368.
• [7]Beral V.Breast cancer and hormone-replacement therapy in the Million Women Study[J].Lancet,2003,362:419-427.
• [8]Reeves GK,Beral V,Green J,et al.Hormonal therapy for menopause and breast-cancer risk by histological type:a cohort study and meta-analysis[J].Lancet Oncology,2006,7:910-918.
• [9]Stahlberg C,Pedersen AT,Andersen ZJ,et al.Breast cancer with different prognostic characteristics developing in Danish women using hormone replacement therapy[J].BJC,2004,91:644-650.
• [10]Saxena T,Lee E,Henderson KD,et al.Menopausal hormone therapy and subsequent risk of specific invasive breast cancer subtypes in the California Teachers Study[J].Cancer Epidemiol Biomarkers Prev,2010,19:2366-2378.
• [11]Simin J,Tamimi R,Lagergren J,et al.Menopausal hormone therapy and cancer risk:An overestimated risk?[J].Eur J Cancer,2017,84:60-68.
• [12]Wang K,Li F,Chen L,et al.Change in risk of breast cancer after receiving hormone replacement therapy by considering effect-modifiers:a systematic review and dose-response meta-analysis of prospective studies[J].Oncotarget,2017,8:81109-81124.
• [13]Fournier A,Berrino F,Riboli E,et al.Breast cancer risk in relation to different types of hormone replacement therapy in the E3N-EPIC cohort[J].Int J Cancer,2005,114:448-454.
• [14]Lyytinen H,Pukkala E,Ylikorkala O.Breast Cancer Risk in Postmenopausal Women Using Estradiol-Progestogen Therapy[J].Obstet Gynecol,2009,113:65-73.
• [15]Baber RJ,Panay N,Fenton A,et al.2016 IMS Recommendations on women's midlife health and menopause hormone therapy[J].Climacteric,2016,19:106-150.
• [16]La Croix AZ,Chlebowski RT,Manson JE,et al.Health outcomes after stopping conjugated equine estrogens among postmenopausal women with prior hysterectomy:a randomized controlled trial[J].JAMA,2011,305:1305-1314.
• [17]Fournier A,Mesrine S,Dossus L,et al.Risk of breast cancer after stopping menopausal hormone therapy in the E3N cohort[J].Breast Cancer Res Treat,2014,145:535-543.
• [18]Cummings SR,Ettinger B,Delmas PD,et al.The effects of tibolone in older postmenopausal women[J].NEJM,2008,359:697-708.
• [19]Maas P,Barrdahl M,Joshi AD,et al.Breast Cancer Risk From Modifiable and Nonmodifiable Risk Factors Among White Women in the United States[J].JAMA Oncol,2016,2:1295-1302.