西方最新研究成果:激素替代疗法会导致乳腺癌

- 2018-11-01 -

Hormone replacement therapy can triple the risk of breast cancer, the biggest ever study has found, following more than a decade of controversy.

史上最大研究发现,经过十多年的争议,激素替代疗法可能使患乳腺癌的风险增加三倍。

Last year the National Institute of Health and Care Excellence(Nice) changed guidance to encourage more doctors to prescribe HRT claiming too many menopausal women had been left suffering in silence.

去年,国家卓越健康与护理研究所(The National Institute of Health and Care Excellence ) 修改指南,鼓励更多的医生在开出激素替代疗法时要声明许多更年期妇女都因此而留下默默忍受痛苦。

HRT is used to treat uncomfortable symptoms of the menopause– such as hot flushes, migraines, disrupted sleep, mood changes and depression – by topping up the decreased levels of hormones produced by the body.

激素替代疗法用来治疗更年期不适症——比如潮热、偏头疼、失眠、脾气大、无精打采----身体产生的激素下降水平达到最高值。

But doctors were reluctant to prescribe it after a study in 2002 suggested it could raise the risk of cancer, a claim later widely disputed.

但是2002年的一项研究认为激素替代疗法可能会增加患癌的危险,之后,医生们都不太愿意用这种疗法了,这项声明后来引起了广泛的争议。

Now new findings by the Institute of Cancer Research and Breast Cancer Now suggest the original risk had actually been underestimated.

现在,国家卓越健康与护理研究所的新发现认为,原说的风险实际上被低估了。

A study of 100,000 women over 40 years found those who took the combined oestrogen and progestogen pill for around five years were 2.7 times more likely to develop cancer compared to women who took nothing, or only the oestrogen pill.

通过对40岁以上的100,000名妇女的研究,发现那些同时服用雌激素和孕激素药丸的人大约在五年时间内发展成癌症的可能性是那些没有服用或只服用孕激素药丸的人的2.7倍。

The risk rose to 3.3 times for women who took the drugs for 15 yearsor more.

那些服用这两种药15年或以上的妇女,其风险高达3.3倍。

Around 14 in 1,000 women in their 50s are expected to develop breast cancer, but that rises to 34 in 1000 for women taking the combined pill, the study suggests.

这项研究认为,大约有14/100050岁的妇女将会患乳腺癌,但如果同时服用这两种药,那么将会有34/1000的妇女会患乳腺癌。

Our research shows that some previous studies are likely to have underestimated the risk of breast cancer with combined oestrogen-progestogen HRT,” said study leader Professor Anthony Swerdlow, of The Institute of Cancer Research.

癌症研究所的项目负责人AnthonySwerdlow教授说“我们的研究表明,前期的某些研究可能低估了激素替代疗法所带来的患乳腺癌的风险,即同时服用雌激素和孕激素药丸。”

We found that current use of combined HRT increases the risk of breast cancer by up to threefold, depending on how long HRT has been used.

“我们发现当前使用的同时服用激素的激素替代疗法加大了患乳腺癌的风险,而且风险高达三倍,(当然)这要取决于激素替代疗法使用的多长时间。

Our findings provide further information to allow women to make informed decisions about the potential risks and benefits of HRT use.”

“我们的发现进一步提供信息,让妇女在做出决定时具有知情权,知道使用激素替代疗法潜在的风险和益处。”

Women taking the oestrogen-only pill have no greater risk

只服用孕激素药丸的妇女,则没有这么大的风险。

HRT was first developed in the 1940s and was first made available to women in Britain in 1965.

激素替代疗法发端于1940s年代,最初在英国妇女身上使用时在1965年。

However in 2002 the British Millennium Women Study published findings claiming that HRT raised the risk of cancer. Many doctors immediately withdrew prescriptions while the Medical Health care and Regulatory Agency (MHRA) issued new guidance recommending all womenbe given the "lowest effective dose should beused for the shortest time."

然而2002年英国千禧妇女研究发表了研究结果,声称激素替代疗法加大了患乳腺癌的风险。许多医生立刻取消了这种处方,医疗保健和监管机构(MHRA)发布新的指导纲要,推荐给予所有妇女“应该使用最低有效剂量,服用时间最短。”

Since then the number of women taking HRT has more than halved with around one in 10 eligible patients now using thedrugs, approximately 150,000 women.

之后,采取激素替代疗法的女性数量减少一半多,即10个符合条件的患者中大约有1人仍在服用这两种药物,(总数)大约有150000名妇女。

More recently a review by Imperial College and a 10-year studybyNew York University found no evidence of a link, adding further to the confusion and last year the National Institute for Health and Care Excellence (Nice) changed itsguidance to encourage doctors to offer HRT claiming one million women were suffering in silence.

帝国理工学院(ImperialCollege)最新发布的一项评论,以及纽约大学的一项耗时10年的研究没有发现进一步引起慌乱的关联性证据;去年,国家卓越健康与护理研究所(Nice)修改指南,鼓励医生在采取激素替代疗法时要声明有一百万妇女因此种疗法而默默遭受痛苦。

At the time Nice said that the cancer risk was 27 in 1,000 so the new research, which followed 100,000 women for 40 years,increases that risk by 54 per cent.

当时,国家卓越健康与护理研究所说,患癌危险是27/1000,而新的研究跟踪研究了100,000名妇女40年,结果是患癌危险高达54%

The health watchdog said that the new study should not change how doctors prescribed HRT.

We found that current use of combined HRT increases the risk of breast cancer by up to three fold, dependingon how long HRT has beenused” ----Professor Anthony Swerdlow, Institute of Cancer Research

卫生监督机构说,新的研究不应该改变医生怎样开出HRT处方。

“我们发现当前使用的同时服用两种激素药的HRT加大了患乳腺癌的危险,而且高达3倍,这要取决于HRT方法使用的多长时间。”---引自癌症研究所的AnthonySwerdlow教授。

Professor Mark Baker, director of the Centre for Guidelines at NICE,said: “As with Nice guidance this study recognisesthere is no increased risk of breast cancer with oestrogen-only HRT but the combined HRT can be associated with anincreased risk ofbreast cancer.

国家卓越健康与护理研究所指导纲要中心主任MarkBaker教授,说:“至于国家卓越健康与护理研究所的指导纲要,这项研究承认如果只服用雌激素的HRT没有加大患乳腺癌的风险,但是如果同时服用两种激素的HRT可能与增加患乳腺癌的风险有关系。”

The guideline makes clear that menopausal women should be informed that the impact of HRT on the risk of breastcancer varies with the type of HRT used.

“指导纲要清楚的表明应该告知更年期妇女HRT产生的患乳腺癌的风险影响因HRT使用的类型的不同而不同。

The message from our guidance to women isclear– talk about the menopause with your clinician ifyou need advice on your symptoms - it’s very important to discuss the options to find what might helpyou.”

“我们给妇女的指导纲要中的信息很清楚----如果你需要得到关于你的症状的建议时,要讲你的更年期告诉给临床医生----讨论哪种选择有助于你是非常重要的。”

The new study also found that the risk declined when women stopped taking HRT and there was no danger at all for women only taking oestrogen, which accounts for half of all prescriptions.

最新研究也发现,当妇女停用HRT时风险就降低了,对于只服用雌激素的妇女来说,根本没有任何危险,这占有所有处方的一半之多。

Baroness Delyth Morgan, chief executive at Breast Cancer Now, said: “Whether to use HRT is an entirely personal choice, which is why it’s so important that women fully understand the risks and benefits and discuss them with their GP. We hope these findings will help anyone considering the treatment to make an even more informed decision.

“今日乳腺癌”机构的董事长BaronessDelythMorgan说:“是否采用HRT完全是个人的选择,这是为什么说妇女要完全了解并与从业医生讨论此法的风险和益处是如此的重要。我们希望这些发现有助于任何想考虑此种治疗的人,并作出一个具有更多知情权的决定。”

On balance, some women will feel HRT to be a necessity. But in order to minimise the risk of breast cancer during treatment, it is recommended that the lowest effective dose is used for the shortest possible time.

“总的来说,有些妇女会觉得HRT是必需的方法。但为了在治疗期间减小患乳腺癌的风险,建议大家服用最小的有效剂量,服用时间尽可能最短。

The good news is that the increased risk of breast cancer begins to fall once you stopusing HRT.”

“好消息是,一旦停用HRT,患乳腺癌的风险就开始降低了”