共识与争议:绝经激素治疗与乳腺癌发病风险

绝经激素治疗(menopausal hormone therapy,MHT)是以雌激素补充为核心的治疗,在有子宫的女性治疗中往往需联合雌激素和孕激素。妇科内分泌和乳腺外科专家就围绝经期MHT是否增加乳腺癌风险展开讨论并达成共识:MHT可增加乳腺癌风险,应用时需全面评估风险与收益;MHT存在用药窗口期、用药指征、禁忌证,应用前需告知患者相关风险并取得知情同意。对天然孕激素、替勃龙及单雌激素治疗是否增加乳腺癌发生风险等问题仍存在争议。

Consensus and Controversy: Menopausal Hormone Therapy and the Risk of Breast Carcinoma

Menopausal hormone therapy (MHT) is the medical treatment that mitigates menopausal symptoms with administration of supplementary sexual hormones. Estrogen and progesterone are often involved in MHT. Experts from the Department of Gynecologic Endocrine and the Department of Breast Surgery have paid special attention to the risk of breast carcinoma related to MHT and reached consensuses on the following issues:MHT increases the risk of breast carcinoma; decision should be made after a careful and comprehensive assessment of the risk of breast carcinoma and the potential benefit of MHT. Since the administration of MHT has a window period, a thorough discussion with patients is essential to fully inform the indication and contraindication of MHT, and an informed consent should be obtained. There are still controversies over the risk of breast carcinoma with natural progesterone, tibolone, and single estrogen.