更年期婦女荷爾蒙補充療法與乳癌之探討

Exploring the Relationship of Hormone Replacement Therapy and Breast Cancer

沈宛真(Wan-Chen Shen)

指導教授 ： 湯澡薰

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2009年)

摘要

隨著醫藥、生活環境及營養的改善，目前人口結構分佈已逐漸傾向老化，全世界停經人口數亦逐年增加；而此時的婦女常在停經後因體內雌激素缺乏而出現許多不適的症狀，因此多以「荷爾蒙補充療法」(Hormone replacement therapy)改善其症狀、提昇生活品質。但美國國家衛生研究院於2002年美國醫學會雜誌(JAMA)發表長期追蹤婦女健康之更年期婦女關懷研究指出，長期使用荷爾蒙補充療法的婦女，其乳癌發生率有明顯地增加，許多相關研究亦應運而生，結果皆顯示長期服用雌激素及黃體素之婦女確實有較高之乳癌罹患風險。
本研究鎖定經醫師診斷為停經症候群之婦女為研究族群，利用國家衛生研究院所提供之1999年至2006年全民健保資料庫依觀察對象納入條件及排除條件整理歸人後，共得到883,052位經門診診斷為停經症候群且曾服用荷爾蒙補充療法藥品之觀察婦女資料。另設定本研究之依變項為乳癌發生結果，自變項為雌激素累積標準用量、是否併用黃體素、觀察時間，控制變項為婦女年齡、居住區域、所屬區域都市化程度，其次再透過存活分析(survival analysis)探討服用不同劑量荷爾蒙之婦女間乳癌發生率之差異。
本研究結果發現，荷爾蒙補充療法之雌激素藥品使用上，無論在每日使用量及累積使用量與乳癌發生之風險確實有其正相關，而此類婦女若併用黃體素藥品一起使用，更將提高其罹癌風險；在年齡方面，其年齡與罹患乳癌風險並非成一直線關係，而是為曲線關係，其中以50-59歲年齡層之婦女風險最高，而70歲以上之婦女若由此時啟用荷爾蒙補充療法，相對風險性則較低；在居住地區方面，居住於台北地區之使用荷爾蒙補充療法停經婦女其罹患乳癌之風險較其他地區為高，而全台中則是以南部地區之風險最低；另在都市化程度部份，隨著都市化程度越高，使用荷爾蒙補充療法停經婦女其罹患乳癌風險便隨之增高，此亦可能與生活型態及飲食習慣有相關之可能。
雖然根據目前研究指出荷爾蒙藥物有效預防更年期婦女骨質疏鬆、心血管疾病及子宮內膜癌等疾病，但相對而言，對於此類婦女罹患乳癌之風險亦可能隨之加增，而高風險族群或長期使用之婦女尤甚。因此，對於因停經症候群求診之婦女應予以最適之治療方式。並期待未來有針對國內現況所分析之進一步研究發表，以達到國內婦女保健之提升。

關鍵字

荷爾蒙補充療法 ； 乳癌 ； 全民健保資料庫

並列摘要

Background:
Along with the medicine, the living conditions and the nutrition improvement, the population structure gradually has become the aged tendency at present, and relatively the menopause population of the world also increases year by year. At this time women often has many ill symptoms due to the lack of estrogen, and therefore use hormone replacement therapy to improve ill symptoms and promote life quality. However, the study was published in 2002 JAMA by WHI point out that, the rate of breast cancer had increases obviously in the long-term use hormone replacement therapy women, and many correlation researches also show similar results.
Methods:
This is a retrospective study comparing the breast cancer rate of 883, 052 women who had postmenopausal syndrome and use hormone replacement therapy during 1999- 2006 in Taiwan and discuss the variables of cumulative estrogen dosage, if combination use of progesterone, observation time, age, residence area and the level of urbanization. Survival analysis was performed to estimate the likelihood of incidence of breast cancer among women of different use dosage of hormones.
Results:
Compared with estrogen use dosage, the risk of breast cancer incidence was significantly higher as the dosage increased and the risk will be enhanced if combining with progesterone. In age, the women aged 50-59 years had the highest risk of breast cancer, but the relative risk will be reduced if women start using hormone replacement therapy while over 70 years. In the residence area, women lived in Taipei had the higher relative risk of breast cancer and women lived in southern region had the lowest risk; on the other hand, the risk of breast cancer was higher as the urbanization level increased, and lifestyle and dietary habits may have related.
Conclusion:
At present although studies shows the great benefits of hormone replacement therapy to menopausal women in prevention of osteoporosis, cardiovascular disease and endometrial cancer, for such women the risk of breast cancer may also increase, especially for high-risk or long-term use group. Therefore, women of postmenopausal syndrome should be provided suitable therapy according as individual situation.

並列關鍵字

hormone replacement therapy ； breast cancer ； NHIRD

參考文獻

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