乳腺癌可否采用绝经激素治疗

Is menopaisal hormone therapy suitable for breast cancer?

孕激素治疗可以增加乳腺癌的风险。文章的实验数据对激素治疗中所有可用的孕激素和激素类避孕药中所有的孕激素进行了比较,结果表明,孕激素对乳腺癌发生风险的影响可能存在差异,尤其对正常乳腺上皮细胞和恶性乳腺上皮细胞风险存在差异。妇女健康启动(WHI)研究表明,不同于单一雌激素治疗,雌孕激素联合治疗可增加乳腺癌风险。然而,目前的临床研究没有区分孕激素的种类,大部分研究数据较少,并且大多数研究中采用的是安宫黄体酮或炔诺酮。然而证据表明,黄体酮和地屈孕酮对乳腺癌的风险可能较低,这还需要进一步的临床研究。绝经后的乳腺癌患者是否可以应用激素治疗?因数据极少,尚不能为临床提供有价值的参考依据,但国际绝经学会及中国绝经学组激素治疗指南均将乳腺癌患者列为绝经激素治疗的禁忌。

Adding progestogens to estrogens can in- crease the risk of breast cancer. However, our experi- mental results, comparing all available progestogens used in hormone therapy and hormonal contraceptives, present high evidence that there may be differences regarding breast cancer risk between the effect of on benign and malignant breast epithelial cells. Women＇s Health Initiative demonstrated an increased risk under combined estrogerdprogestogen-, but not under es- trogen-only therapy. However, up to now the clinical studies can not discriminate the various progestogens mostly due to too small patient numbers in the sub- groups, and in most studies either medroxyprogesterone acetate or norethisterone has been used. However, there is evidence that the natural progesterone and dydro- gesterone may have fewer risks, but this must be proven in further clinical trials.Could menopause patients with breast cancer use MHT？ Because there is not enough data on menopause patients with breast cancer who use MHT, it is not a valuable reference for the clinical use. But both the International Menopause Society MHT guideline and Chinese MHT guideline propose that HMT is contraindication for breast cancer patients.