Περίληψη:
Considerable experimental and epidemiological evidence suggests that
elevated endogenous sex steroids - notably androgens and oestrogens -
promote breast tumour development. In spite of this evidence,
postmenopausal androgen replacement therapy with dehydroepiandrosterone
(DHEA) or testosterone has been advocated for the prevention of
osteoporosis and improved sexual wellbeing. We have conducted a
case-control study nested within the European Prospective Investigation
into Cancer and Nutrition. Levels of DHEA sulphate (DHEAS), (Delta
4-androstenedione), testosterone, oestrone, oestradiol and sex-hormone
binding globulin (SHBG) were measured in prediagnostic serum samples of
677 postmenopausal women who subsequently developed breast cancer and
1309 matched control subjects. Levels of free testosterone and free
oestradiol were calculated from absolute concentrations of testosterone,
oestradiol and SHBG. Logistic regression models were used to estimate
relative risks of breast cancer by quintiles of hormone concentrations.
For all sex steroids the androgens as well as the oestrogens - elevated
serum levels were positively associated with breast cancer risk, while
SHBG levels were inversely related to risk. For the androgens, relative
risk estimates (95% confidence intervals) between the top and bottom
quintiles of the exposure distribution were: DHEAS 1.69 (1.23-2.33),
androstenedione 1.94 (1.40-2.69), testosterone 1.85 (1.33-2.57) and free
testosterone 2.50 (1.76-3.55). For the oestrogens, relative risk
estimates were: oestrone 2.07 (1.42-3.02), oestradiol 2.28 (1.61-3.23)
and free oestradiol (odds ratios 2.13 (1,52-2.98)). Adjustments for body
mass index or other potential confounding factors did not substantially
alter any of these relative risk estimates. Our results have shown that,
among postmenopausal women, not only elevated serum oestrogens but also
serum androgens are associated with increased breast cancer risk. Since
DHEAS and androstenedione are largely of adrenal origin in
postmenopausal women, our results indicated that elevated adrenal
androgen synthesis is a risk factor for breast cancer. The results from
this study caution against the use of DHEA(S), or other androgens, for
postmenopausal androgen replacement therapy.
Συγγραφείς:
Kaaks, R
Rinaldi, S
Key, TJ
Berrino, F
Peeters, PHM and
Biessy, C
Dossus, L
Lukanova, A
Binghan, S
Khaw, KTG and
Allen, NE
Bueno-De-Mesquita, HB
van Gils, CH
Grobbee, D and
Boeing, H
Lahmann, PH
Nagel, G
Chang-Claude, J and
Clavel-Chapelon, F
Fournier, A
Thiebaut, A
Gonzalez, CA and
Quiros, JR
Tormo, MJ
Ardanaz, E
Amiano, P
Krogh, V and
Palli, D
Panico, S
Tumino, R
Vineis, P
Trichopoulou, A
and Kalapothaki, V
Trichopoulos, D
Ferrari, P
Norat, T and
Saracci, R
Riboli, E
