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【medical-news】超重年轻女性绝经前患乳腺癌的风险降低

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Source: JAMA and Archives Journals
Date: November 28, 2006

Overweight Young Women Have Reduced Risk Of Developing Breast Cancer Before Menopause
A higher body mass index (BMI), especially in early adulthood, may be associated with a reduced risk of breast cancer before menopause, according to an article in the November 27 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. This association does not appear to be related to ovulation problems that overweight women may develop.

Previous studies have observed an association between higher body mass index and a lower risk of breast cancer, according to background information in the article. High BMI can be associated with irregular or long menstrual cycles and the development of polycystic ovary syndrome, a condition that occurs when the ovaries malfunction, decreasing fertility and contributing to other illnesses. All of these are related to disruptions in ovulation, which decrease levels of the hormones estradiol and progesterone; the long-held belief was that these lower levels, in turn, might explain the decrease in breast cancer risk. "However, few studies have explored whether these or other factors provide mechanistic insights into the unexpected protection that a high body mass confers on the premenopausal breast," the authors write.

Karin B. Michels, Sc.D., Ph.D., Brigham and Women's Hospital and Harvard Medical School, Boston, and colleagues studied 113,130 premenopausal women who were part of the Nurses' Health Study II, a large group of female registered nurses who have been followed since 1989. At the beginning of the study, the women provided information about their adult height and their weight at age 18, as well as their current weight, any fertility problems, their family history of breast cancer and the characteristics of their menstrual cycle. Follow-up questionnaires that included questions about breast cancer and benign breast disease, childbirth, alcohol consumption, oral contraceptive use and physical activity were filled out every two years. The women were followed until 2003 or until they developed breast or any other cancer, died or reached menopause, whichever happened first.

Between 1989 and 2003, 1,398 cases of invasive breast cancer occurred among the women. Those with a current BMI of 30 or higher had a 19 percent lower risk of breast cancer compared with those who had a BMI between 20 and 22.4, after adjusting for family history, personal characteristics, lifestyle habits and menstrual variables. Women whose BMI was 27.5 or higher at age 18 had a 43 percent lower risk of developing breast cancer than those whose 18-year-old BMI was between 20 and 22.4. This association did not change when the researchers considered current BMI.

"A high BMI during adulthood is highly correlated with a high body mass during adolescence, which may be more important for the development of breast cancer before menopause," the authors write. "Although a high birth weight has been fairly consistently linked to an increase in the risk of premenopausal breast cancer, the BMI-breast cancer association seems to reverse at some point during the first years of life, only to revert back after menopause," when breast cancer is most often diagnosed.

Because the failure to ovulate (anovulation) cannot be measured directly, these findings do not rule out the hypothesis that factors related to ovulation contribute to the protective effect of a high BMI. "However, because adjustment for menstrual cycle patterns, infertility due to ovulatory disorder, probable polycystic ovary syndrome and use of oral contraceptives did not even slightly attenuate the association with BMI, anovulation does not seem to be a primary explanation for the reduced risk in heavier women," the authors conclude. "Among women with no history of infertility due to an ovulatory disorder, the inverse association between BMI and premenopausal breast cancer incidence persisted, lending further support to the role of mechanisms other than anovulation." The link may be hormonal, or due to the fact that obese women are less likely to be screened for breast cancer.

http://www.sciencedaily.com/releases/2006/11/061128084438.htm

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2006-11-29 12:46 浏览 : 389 回复 : 4

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2006-11-29 12:55

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Overweight Young Women Have Reduced Risk Of Developing Breast Cancer Before Menopause
A higher body mass index (BMI), especially in early adulthood, may be associated with a reduced risk of breast cancer before menopause, according to an article in the November 27 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. This association does not appear to be related to ovulation problems that overweight women may develop.
根据11月27日版的《美国内科文献》（美国医学会杂志之一）一篇文章，绝经前特别是年轻女性高体重指数可能降低乳腺癌的风险。这种现象与超重引起的排卵障碍没有关联。
Previous studies have observed an association between higher body mass index and a lower risk of breast cancer, according to background information in the article. High BMI can be associated with irregular or long menstrual cycles and the development of polycystic ovary syndrome, a condition that occurs when the ovaries malfunction, decreasing fertility and contributing to other illnesses. All of these are related to disruptions in ovulation, which decrease levels of the hormones estradiol and progesterone; the long-held belief was that these lower levels, in turn, might explain the decrease in breast cancer risk. "However, few studies have explored whether these or other factors provide mechanistic insights into the unexpected protection that a high body mass confers on the premenopausal breast," the authors write.
以往的研究已经发现，高体重指数与乳腺癌风险降低有关联。高BMI可伴有月经紊乱、周期延长和多囊卵巢综合征。后者表现为卵巢功能障碍、生育力下降及由此引起的其它疾病。所有这些症状与引起雌孕激素水平下降的排卵障碍有关。高BMI为何乳癌风险降低，人们一直用雌孕激素水平下降来解释。不过很少有探讨这些或其它因素参与高BMI绝经前妇女乳房保护的机理。
Karin B. Michels, Sc.D., Ph.D., Brigham and Women's Hospital and Harvard Medical School, Boston, and colleagues studied 113,130 premenopausal women who were part of the Nurses' Health Study II, a large group of female registered nurses who have been followed since 1989. At the beginning of the study, the women provided information about their adult height and their weight at age 18, as well as their current weight, any fertility problems, their family history of breast cancer and the characteristics of their menstrual cycle. Follow-up questionnaires that included questions about breast cancer and benign breast disease, childbirth, alcohol consumption, oral contraceptive use and physical activity were filled out every two years. The women were followed until 2003 or until they developed breast or any other cancer, died or reached menopause, whichever happened first.
美国布莱根妇女医院、哈佛大学医学院Karin B. Michels博士及其同事对113.130名绝经前妇女进行了研究，她们是护士健康研究II的一部份，是一组注册护士，自1989开始随访。研究开始时，妇女提供成人身高、18岁时以及目前的体重、生育情况、乳癌家族史和月经周期特征。每2年填写随访调查表，内容包括乳癌和良性乳房疾病、生育、酒精消费、口服避孕药使用、体力活动情况。随访截止日期为2003年或发生乳癌或其它肿瘤，或死亡或绝经。
Between 1989 and 2003, 1,398 cases of invasive breast cancer occurred among the women. Those with a current BMI of 30 or higher had a 19 percent lower risk of breast cancer compared with those who had a BMI between 20 and 22.4, after adjusting for family history, personal characteristics, lifestyle habits and menstrual variables. Women whose BMI was 27.5 or higher at age 18 had a 43 percent lower risk of developing breast cancer than those whose 18-year-old BMI was between 20 and 22.4. This association did not change when the researchers considered current BMI.
1989到2003年，共有1398例发生浸润性乳腺癌。调整家族史、个人特征、生活习惯和月经变量后，与BMI为22-22.4的妇女相比，BMI大于和等于30的妇女的乳癌的风险下降19%。18岁时BMI大于等于27.5的妇女与18岁时BMI为20-22.4的妇女相比，乳癌风险下降43%。研究者考虑现在BMI时，这种关系并没有变化。
"A high BMI during adulthood is highly correlated with a high body mass during adolescence, which may be more important for the development of breast cancer before menopause," the authors write. "Although a high birth weight has been fairly consistently linked to an increase in the risk of premenopausal breast cancer, the BMI-breast cancer association seems to reverse at some point during the first years of life, only to revert back after menopause," when breast cancer is most often diagnosed.
成人期高BMI与青春期超重高度相关，青春期的超重可能对绝经前乳癌发生更加重要。尽管高出生体重与绝经前乳癌增加相当一致，但是BMI与乳癌的关系在人生第一阶段某一点上似乎呈相反关系。绝经后不料竟又恢复,这时乳癌常被诊断。
Because the failure to ovulate (anovulation) cannot be measured directly, these findings do not rule out the hypothesis that factors related to ovulation contribute to the protective effect of a high BMI. "However, because adjustment for menstrual cycle patterns, infertility due to ovulatory disorder, probable polycystic ovary syndrome and use of oral contraceptives did not even slightly attenuate the association with BMI, anovulation does not seem to be a primary explanation for the reduced risk in heavier women," the authors conclude. "Among women with no history of infertility due to an ovulatory disorder, the inverse association between BMI and premenopausal breast cancer incidence persisted, lending further support to the role of mechanisms other than anovulation." The link may be hormonal, or due to the fact that obese women are less likely to be screened for breast cancer.
因为不能直接检测排卵障碍，所以这些结果不能否定排卵相关因子参与高BMI的保护作用。不过调整月经周期，排卵紊乱引起的不育、多囊卵巢综合征以及口服避孕药并不降低与BMI的关系，因此停止排卵并不是超重妇女降低风险的主要原因。有排卵紊乱引起不育病史的妇女，BMI与经前乳癌的发病率之间一直存在负相关，进一步支持与排卵停止无关。这种关联可能是激素或者是由于肥胖妇女较少筛查乳癌有关。

2006-12-02 08:36

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xujianhua50 编辑于 2006-12-02 09:44

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11月27日出版的《美国内科文献》（美国医学会杂志之一）报道，绝经前特别是年轻女性高体重指数可能降低乳腺癌的风险。并且指出这种现象与超重引起的排卵障碍没有关联。
以往的研究已经发现，高体重指数与乳腺癌风险降低有关联。高BMI可伴有月经紊乱、周期延长和多囊卵巢综合征。后者表现为卵巢功能障碍、生育力下降及由此引起的其它疾病。所有这些症状与引起雌孕激素水平下降的排卵障碍有关。高BMI为何乳癌风险降低，人们一直用雌孕激素水平下降来解释。不过很少有探讨高BMI对绝经前妇女乳房保护的机理。
美国布莱根妇女医院、哈佛大学医学院Karin B. Michels博士及其同事对113.130名绝经前注册护士进行了研究，自1989开始随访。研究开始时，妇女提供成年身高、18岁时以及目前的体重、生育、乳癌家族史和月经周期情况。每2年填写随访调查表，内容包括良恶性乳房疾病、生育、酒精消费、口服避孕药、体力活动情况。随访截止日期为2003年或发生乳癌或其它肿瘤，或死亡或绝经。
1989到2003年，共有1398例发生浸润性乳腺癌。调整家族史、个人特征、生活习惯和月经变量后，BMI大于等于30的妇女乳癌发生风险，与BMI22-22.4的相比，下降19%。18岁时BMI大于等于27.5的妇女与18岁时BMI为20-22.4的妇女相比，乳癌风险下降43%。
因为不能直接检测排卵障碍，所以这些结果不能否定排卵相关因子参与高BMI的保护作用。调整月经周期，排卵紊乱引起不育、多囊卵巢综合征以及口服避孕药并不降低乳癌发生与BMI的关系，因此停止排卵并不是超重妇女降低风险的主要原因。往有排卵紊乱引起不育病史的妇女，BMI与经前乳癌发病率之间一直存在负相关，进一步支持与排卵停止无关。这种关联可能是激素或者是由于肥胖妇女较少筛查乳癌。

2006-12-02 09:16

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xujianhua50 编辑于 2006-12-02 09:30

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