激素治疗干扰乳腺癌的诊断
Hormone therapy skews breast cancer diagnosisCHICAGO (Reuters) - Women on hormone replacement therapy have only a slightly higher risk of developing breast cancer, but there are much greater chances they will experience the worry of abnormal mammograms or may undergo an avoidable breast biopsy, researchers said on Monday.
Mammograms and biopsy exams were also found to be less reliable at detecting breast cancer among women taking hormones, which counteract symptoms of menopause such as hot flashes and vaginal dryness.
Originally, the 2002 Women's Health Initiative study involving 16,608 women aged 50 to 79 found breast cancer incidence among women taking the hormones estrogen and progestin projected to an additional one in 1,000 cases compared to women taking an inert placebo.
\"What this data does is emphasize that yes, the breast cancer risk is still there, but more importantly, instead of that low number of one in 1,000 getting breast cancer, one in 10 women are told they had an abnormal mammogram they'll have to deal with, and probably even more importantly, one in 25 women will have an otherwise avoidable breast biopsy,\" Dr. Rowan Chlebowski at the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center said in a telephone interview.
\"Both of those less reliably found cancer,\" he added.
Previous research has shown hormone replacement therapy increases breast tissue density, which can make detection of cancerous tumors more difficult, although the current study did not examine this factor.
Since the original findings of increased cancer risk, doctors generally have urged women opting for hormone therapy to use it at the lowest effective dose for the shortest possible time.
Roughly 25 million U.S. prescriptions for hormone therapy are written yearly, Chlebowski said.
The pharmaceutical company Wyeth said in a statement the study's findings did not change what is already known about the breast cancer risk from hormone replacement therapy.
DOCTOR'S ADVICE
\"These findings represent a concern for post-menopausal women who are considering hormone therapy,\" Chlebowski said in a statement. \"They should take the results of this study into consideration and consult with their physicians before undergoing even short-term hormone therapy.\"
In the study published in the Archives of Internal Medicine, 35 percent of women taking hormones had mammograms with abnormal results compared to 23 percent of women taking a placebo. An abnormal test can create emotional as well as financial hardships, the study noted.
Ten percent of women taking hormones had breast biopsies ordered by their doctors, compared to 6 percent of women taking a placebo.
During the 5-1/2 years of the study, there were 199 breast cancers found in the hormone group and 150 in the placebo group. Women taking hormones had more advanced cancers yet biopsies ordered by their doctors had a lower rate of diagnosis -- 15 percent in the hormone group versus 20 percent in the placebo group.
\"(A year) after discontinuation (of the therapy) ... the adverse effects on mammogram and breast biopsy performance were seen even in younger women in the fifth decade of life, so the finding may impact women just entering menopause as well,\" Chlebowski said.
http://www.reuters.com/article/healthNews/idUSN2524664120080225
芝加哥（路透社）----研究者们周一指出，接受激素替代治疗的女性罹患乳腺癌的可能性仅仅轻度增高，但是她们面临更多因乳腺X线检查异常而担忧或者接受本可避免的组织活检。
激素替代能改善女性绝经后的症状，如潮热和阴道干燥。对激素替代治疗的女性乳房X线检查和活检也是不太可靠的乳腺肿瘤检测方法。
最初，2002年妇女健康启动研究纳入了16,608名50到79岁的女性，研究发现服用雌激素和孕激素组与服用无活性的安慰剂组女性相比，乳腺癌患病率每1,000人增加1例。
Harbor-UCLA医学中心洛杉矶生物医学研究所Rowan Chlebowski博士接受电话采访时说：“这些数据表明乳腺癌的风险仍旧存在，风险并非低到1,000女性中一个，10个中就有一个被告知X线检测异常需要处理，可能25人中有一个需要组织活检。（翻译不准）”
他补充道：“这些检测方法都不可靠。”
既往的研究显示激素替代治疗增加乳腺组织密度，即使当前的研究并未检测该因素，但是会导致乳腺癌检测更困难。
考虑到原先已发现其增加肿瘤的风险，医生们通常建议妇女们选择尽可能短时间的小剂量激素治疗。
Chlebowski说每年美国大约有二千五百万张激素治疗的处方。
惠氏制药公司在一份声明中说，该研究并未发现激素替代治疗会导致乳腺肿瘤风险性增加。
医生的建议
Chlebowski在一份声明中说：“这个研究显示了对激素替代治疗的绝经期女性的关注。她们应当获知这个研究的结果，即使接受短期激素治疗也应当考虑并和她们的医生商讨。”
发表在的《内科学年鉴》的研究显示，乳房X线照片异常激素治疗组为35%，而安慰剂组为23%。研究表明检查结果异常会使患者产生不良情绪如同财务危机一样。
激素治疗组遵照医生建议行乳腺活检比例为10%，而安慰剂组为6%。
在5年半的研究中，激素组发现199例乳腺癌，安慰剂组150例乳腺癌患者。激素组即使遵医嘱进行了组织活检仍然早期诊断率偏低，导致较多的发展到晚期肿瘤----激素组诊断率15%，而安慰剂组为20%。
Chlebowski说：“即使停止激素治疗一年后，50岁左右的女性仍然可见到其对X线乳腺检查和活检的不良影响，这个结论仅仅是影响围绝经期女性。”
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