Postmenopausal Hormone Therapy (Risk of Breast cancer)

소개

주요 질환인 유방암의 위험인자로 폐경후 호르몬 치료의 위험성에 대해 다룬 레포트입니다. 산부인과 교과서와 각종 최신 논문들을 참조하여 만든 자료로서 최신 견해까지 포함된 고급 자료입니다. 의과대학, 간호대학 학생들의 발표자료 및 레포트 제출용으로 좋은 활용하시길 바랍니다.

목차

Risk of Breast Cancer (Postmenopausal Hormone Therapy)
I. Risk factors of Breast Cancer
1. Endogenous Hormones
2. Obesity and weight gain
3. Other Risk Factors
II. Estrogen-Progestin Combination Therapy
III. Unopposed Estrogen
IV. Abnormal Mammography
V. Prior HRT
VI. Estrogen-Receptor
VII. Gap Time
VIII. 호르몬 치료에 관한 권고안( 대한폐경학회,2003, North American Menopause Society, 2004)
IX. 호르몬 요법에 대한 입장표명 (세계폐경학회 : 2007, 아태폐경학회 : 2008

본문내용

Breast Cancer
Most common cancer in women
Second leading cause of cancer death
Lifetime risk of developing invasive breast cancer(US) : 12%
Berek and Novak’s Gynecology, 14th Edition

Breast Cancer
Risk factors for breast cancer
Age, Early menarche, Late menopause, Family history, Prior breast disease(Epithelial atypia & cancer)
Prolonged estrogen exposure
Long-term use of HT(>5yrs) : RR 1.3
Reduced risk
Oophorectomy
Term pregnancy before the age of 30
may be Lowered with use of Estrogen Alone
Berek and Novak’s Gynecology, 14th Edition

<중 략>

Prognosis
Taking Estrogen
relatively GOOD prognosis
Combined Estrogen-Progestin Therapy
Similar Grade and Histology
Larger Size
NOT clinically important
More Advanced Stage
Regional/Metastatic (25% vs 16%)

Conclusion
HRT : 폐경기 증상의 가장 확실하고 효과적인 치료법
특별한 폐경기 증상이 없다면 가능한 사용을 자제
장기적 사용이 필요한 경우, 이득과 위험성에 대해 환자와 충분한 논의를 한 다음 사용하고 close monitoring
WHI 후속 연구
50대 폐경 여성에게 HRT를 처음 투여하는 경우 유방암의 위험도는 증가하지 않는다는 것이 명확해짐
앞으로의 연구방향
이전 HRT 사용자에서 다시 HRT를 처방할 수 있는지? 그럴 경우 언제까지 사용해야 하는지?
CEE＋MPA 약제 외에 다른 약제의 영향은 어떠한지?

참고자료

· Jonathan S. Berek, Berek & Novak’s Gynecology, 14th Edition, Lippincott Williams, 2006
· Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women`s Health Initiative randomized controlled trial. JAMA 2002
· Chlebowski RT, Hendrix SL, Langer RD, Stefanick ML, Gass M, Lane D, et al. Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women`s Health Initiative randomized trial. JAMA 2003; 289: 3243-53.
· Anderson GL, Limacher M, Assaf AR, Bassford T, Beresford SA, Black H, et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women`s Health Initiative randomized controlled trial. JAMA 2004; 291: 1701- 12.
· Stefanick ML, Anderson GL, Margolis KL, Hendrix SL, Rodabough RJ, Paskett ED, et al. Effects of conjugated equine estrogens on breast cancer and mammography screening in postmenopausal women with hysterectomy. JAMA 2006; 295: 1647-57.
· McTiernan A, Martin CF, Peck JD, Aragaki AK, Chlebowski RT, Pisano ED, et al. Estrogen-plusprogestin use and mammographic density in postmenopausal women: women`s health initiative randomized trial. J Natl Cancer Inst 2005; 97: 1366-76.
· Anderson GL, Chlebowski RT, Rossouw JE, Rodabough RJ, McTiernan A, Margolis KL, et al. Prior hormone therapy and breast cancer risk in the Women`s Health Initiative randomized trial of estrogen plus progestin. Maturitas 2006; 55: 103-15.
· Chlebowski RT, Anderson GL, Lane DS, Aragaki AK, Rohan T, Yasmeen S, et al. Predicting risk of breast cancer in postmenopausal women by hormone receptor status. J Natl Cancer Inst 2007; 99: 1695-705.
· Heiss G, Wallace R, Anderson GL, Aragaki A, Beresford SA, Brzyski R, et al. Health risks and benefits 3 years after stopping randomized treatment with estrogen and progestin. JAMA 2008; 299: 1036-45.
· Prentice RL, Chlebowski RT, Stefanick ML, Manson JE, Pettinger M, Hendrix SL, et al. Estrogen plus progestin therapy and breast cancer in recently postmenopausal women. Am J Epidemiol 2008; 167: 1207-16.