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폐경 여성에서 3년 동안 호르몬 요법, Raloxifene, Alendronate 치료 후 유방밀도의 변화

Effects of 3 Years of Hormone Therapy, Raloxifene, and Alendronate on Mammographic Breast Density in Postmenopausal Korean Women

최훈|김명환
대한폐경학회 (Korean Society Of Menopause)|2011.08|대한폐경학회지 (Journal of Menopausal Medicine)|제17권 제2호|pp. 94-101|DOI http://dx.doi.org/

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참고문헌

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폐경Menopause유방밀도AlendronateRaloxifeneHormone therapy호르몬 요법Mammographic breast density

초록

연구목적: 유방밀도는 침윤성 유방암의 독립적인 위험인자이다. 한국 폐경 여성에서 호르몬 요법, raloxifene, alendronate가 유방촬영술의 유방밀도에 미치는 영향을 평가하였다. 연구재료 및 방법: 의무기록을 통해 2000년 1월에서 2010년 6월까지 상계백병원 산부인과에서 3년 간 호르몬 요법, raloxifene, alendronate 치료 중 한 가지를 받은 폐경 여성 중 선별된 127 명을 대상으로 후향적 연구를 시행하였다. 이들을 alendronate군 (n = 26), raloxifene군 (n = 18), 에스트로겐 요법군 (estrogen therapy, ET) (n = 43), 지속적 에스트로겐-프로게스테론 병합요법군 (estrogen-progesterone therapy, EPT) (n = 20), 주기적 에스트로겐-프로게스테론 병합 요법군 (n = 20)으로 나누어 기저치와 치료 1년, 2년, 3년 후 Breast Image Reporting and Data System (BI-RADS)의 분류에 의한 유방밀도를 비교하였다. Alendronate군, raloxifene군, 호르몬 요법군과 호르몬 요법 각 군 간의 유방밀도도 비교하였다. 결과: BI-RADS에 의한 유방밀도는 raloxifene군에서 1년 후 유의하게 감소하였고 (P = 0.04) 2년, 3년 후에는 유의한 감소는 없었다 (각각 P = 0.19, 0.19). ET군에서는 유방밀도가 3년 후 유의하게 증가하였고 (P = 0.03) 지속적 EPT군에서는 1년, 2년, 3년 후 유의한 증가가 있었으며 (각각 P = 0.01, ＜ 0.001, ＜ 0.001) 주기적 EPT군에서는 2년, 3년 후 유의한 증가가 있었다 (각각 P = 0.04, 0.02). Alendronate군에서 유의하지는 않지만 유방밀도가 1년, 2년, 3년 후 감소하는 경향을 보였다 (각각 P = 0.08, 0.1, 0.1). Raloxifene군에서 호르몬 요법군보다 1년, 2년, 3년 후 유방밀도가 유의하게 낮았다 (각각 P = 0.002, 0.001, 0.001). 3년 후에는 alendronate군에서도 호르몬 요법군보다 유방밀도가 유의하게 낮았다 (P = 0.010). 결론: 호르몬 요법군에서 유방밀도의 유의한 증가가 있는 반면 raloxifene군에서는 유의한 감소가 있었고 alendronate군에서도 감소하는 경향을 보였다. Raloxifene와 alendronate의 유방밀도에 대한 효과를 결정하기 위해서는 전향적인 대규모의 연구가 필요하다고 생각된다.

Abstract

Objectives: Breast density is an independent risk factor for the development of invasive breast cancer. We conducted this study to evaluate the effects of 3 years of hormone therapy, raloxifene, and alendronate on mammographic breast density in postmenopausal Korean women. Methods: We studied 127 postmenopausal women who had visited the Department of Obstetrics and Gynecology of Inje University Sanggye Paik Hospital between January 2000 and June 2010. These patients were divided into the following 5 groups: alendronate (n = 26); raloxifene (n = 18); estrogen therapy (ET; n = 43); continuous estrogen-progesterone therapy (EPT; n = 20); and cyclic EPT (n = 20). The Breast Image Reporting and Data System (BI-RADS) composition grade 1, 2, and 3 years after treatment was compared with the BI-RADS composition grade at baseline. Results: The BI-RADS grade decreased significantly in the raloxifene group at 1 year (P = 0.04). The BI-RADS grade increased significantly in the ET group at 3 years (P = 0.03), in the continuous EPT at 1, 2, and 3 years (P = 0.01, ＜ 0.001, ＜ 0.001, respectively), and in the cyclic EPT group at 2 and 3 years (P = 0.04 and 0.02, respectively). Although not statistically significant, a decrease in the BI-RADS grade occurred in the alendronate group at 1, 2, and 3 years (P = 0.08, 0.1, and 0.1, respectively). Conclusion: This study showed that there was significant decrease in mammographic breast density at 1 year in the raloxifene group and a decreasing trend in the alendronate group, whereas there was significant increase in the ET and EPT groups. To determine the effect of raloxifene and alendronate on breast density, larger prospective studies are needed.

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