有些更年期或绝经后妇女会选择服用雌激素和孕激素，来缓解这一时期体内激素不足所产生的不适症状。不过，美国一项最新研究显示，这种激素替代疗法会增加妇女患肺癌的风险。
美国加利福尼亚大学洛杉矶分校研究人员在9月刊的英国《柳叶刀》杂志上报告说，他们对超过1．6万名50岁至79岁绝经后妇女的医疗数据进行分析后，得出了上述结论。这些妇女在参加一项健康调查期间，被随机分组，一组服用雌激素和孕激素的混合激素，一组服用安慰剂。在调查开始之前，这些妇女都没有患肺癌。
调查结果显示，8年之后，激素组有73名妇女患肺癌死亡，而安慰剂组有40人死于肺癌。研究人员因此认为，选择激素替代疗法的妇女死于肺癌的风险大大高于不采用此疗法的妇女。
研究人员建议，在采取激素替代疗法之前，妇女应该认真权衡利弊。尤其对于吸烟妇女或者曾经有过长期吸烟史的妇女来说，更应慎重行事。（生物谷Bioon.com）
生物谷推荐原始出处：
The Lancet doi:10.1016/S0140-6736(09)61526-9
Oestrogen plus progestin and lung cancer in postmenopausal women (Women's Health Initiative trial): a post-hoc analysis of a randomised controlled trial
Prof Rowan T Chlebowski MDa, , , Prof Ann G Schwartz PhDb, Heather Wakelee MDc, Garnet L Anderson PhDd, Prof Marcia L Stefanick PhDc, Prof JoAnn E Manson MDe, Rebecca J Rodabough MSd, Jason W Chien MDd, Prof Jean Wactawski-Wende PhDf, Margery Gass MDg, Prof Jane Morley Kotchen MDh, Prof Karen C Johnson MDi, Prof Mary Jo O'Sullivan MDj, Prof Judith K Ockene PhDk, Prof Chu Chen PhDd, Prof F Allan Hubbell MDl and for the Women's Health Initiative Investigators
aLos Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
bDepartment of Internal Medicine, Karmanos Cancer Institute, Detroit, MI, USA
cDepartment of Medicine, Stanford University, Palo Alto, CA, USA
dFred Hutchinson Cancer Research Center, Seattle, WA, USA
eDepartment of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
fDepartment of Social and Preventive Medicine, State University of New York, Buffalo, NY, USA
gUniversity of Cincinnati, Cincinnati, OH, USA
hDepartment of Population Health, Medical College of Wisconsin, Milwaukee, WI, USA
iDepartment of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
jDepartment of Obstetrics and Gynecology, University of Miami, Miami, FL, USA
kDepartment of Medicine, University of Massachusetts, Fallon Clinic, Worcester, MA, USA
lDepartment of Medicine, University of California, Irvine, CA, USA
Background
In the post-intervention period of the Women's Health Initiative (WHI) trial, women assigned to treatment with oestrogen plus progestin had a higher risk of cancer than did those assigned to placebo. Results also suggested that the combined hormone therapy might increase mortality from lung cancer. To assess whether such an association exists, we undertook a post-hoc analysis of lung cancers diagnosed in the trial over the entire follow-up period.
Methods
The WHI study was a randomised, double-blind, placebo-controlled trial undertaken in 40 centres in the USA. 16 608 postmenopausal women aged 50–79 years with an intact uterus were randomly assigned by a computerised, stratified, permuted block algorithm to receive a once-daily tablet of 0·625 mg conjugated equine oestrogen plus 2·5 mg medroxyprogesterone acetate (n=8506) or matching placebo (n=8102). We assessed incidence and mortality rates for all lung cancer, small-cell lung cancer, and non-small-cell lung cancer by use of data from treatment and post-intervention follow-up periods. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00000611.
Findings
After a mean of 5·6 years (SD 1·3) of treatment and 2·4 years (0·4) of additional follow-up, 109 women in the combined hormone therapy group had been diagnosed with lung cancercompared with 85 in the placebo group (incidence per year 0·16% vs 0·13%; hazard ratio [HR] 1·23, 95% CI 0·92–1·63, p=0·16). 96 women assigned to combined therapy had non-small-cell lung cancer compared with 72 assigned to placebo (0·14% vs 0·11%; HR 1·28, 0·94–1·73, p=0·12). More women died from lung cancer in the combined hormone therapy group than in the placebo group (73 vs 40 deaths; 0·11% vs 0·06%; HR 1·71, 1·16–2·52, p=0·01), mainly as a result of a higher number of deaths from non-small-cell lung cancer in the combined therapy group (62 vs 31 deaths; 0·09% vs 0·05%; HR 1·87, 1·22–2·88, p=0·004). Incidence and mortality rates of small-cell lung cancer were similar between groups.
Interpretation
Although treatment with oestrogen plus progestin in postmenopausal women did not increase incidence of lung cancer, it increased the number of deaths from lung cancer, in particular deaths from non-small-cell lung cancer. These findings should be incorporated into risk–benefit discussions with women considering combined hormone therapy, especially those with a high risk of lung cancer.
Funding
National Heart, Lung and Blood Institute, National Institutes of Health.
